Kinematically Versus Mechanically Aligned Total Knee Arthroplasty
Kinematically Versus Mechanically Aligned Total Knee Arthroplasty
复制标题
DOI：
10.3928/01477447-20120123-04
复制
发表时间：
2012-02-01
期刊：
影响因子：
1.1
通讯作者：
Kwasman, Bertram G.
中科院分区：
文献类型：
--
作者：
Dossett, H. Gene;Swartz, George J.;Kwasman, Bertram G.
本研究旨在比较全膝关节置换术（TKA）的2种对线方法：使用患者特定导向器的运动学对线和使用传统工具的机械对线。对41例运动学对线和41例机械对线患者进行了一项随机对照试验，患者、影像学评价者和临床评价者对线技术不知情。放射学测量由长腿计算机断层扫描扫描照片。术前和术后6个月测量临床结果评分和活动度，两组的髋-膝-踝角（0.3度差异; P = 0.693）和膝关节解剖角（0.8度差异; P = 0.131）相似。与机械对线组相比，运动对线组股骨部件外翻角度多2.4度（P < .000），胫骨部件内翻角度多2.3度（P < .000）。术后6个月，西安大略和麦克马斯特大学骨关节炎指数评分为16分Oxford评分比对照组高7分（P < .000），（P = .001），膝关节协会综合评分优于25分（P = 0.001），屈曲度比前屈大5.0度（P = 0.043）我们的研究结果表明，早期失败的风险与肢体或膝关节对线有关，在运动学和机械对准TKA方面应相似。在运动学对线组中，植入物更多的解剖学对线与更好的屈曲和更好的临床结局评分相关。
The purpose of this study was to compare 2 alignment methods for total knee arthroplasty (TKA): kinematic alignment with the use of patient-specific guides and mechanical alignment with conventional instruments. A randomized, controlled trial of 41 kinematically aligned and 41 mechanically aligned patients was conducted with the patient, radiographic evaluator, and clinical evaluator blinded to the alignment technique. Radiographic measurements were made from long-leg computer tomography scanograms. Clinical outcome scores and motion were measured preoperatively and 6 months postoperatively.The hip-knee-ankle angle (0.3 degrees difference; P = .693) and anatomic angle of the knee (0.8 degrees difference; P = .131) were similar for both groups. In the kinematically aligned group, the angle of the femoral component was 2.4 degrees more valgus (P < .000) and the angle of the tibial component was 2.3 degrees more varus (P < .000) than the mechanically aligned group. At 6 months postoperatively, the Western Ontario and McMaster Universities Osteoarthritis Index score was 16 points better (P < .000), Oxford Score was 7 points better (P = .001), combined Knee Society Score was 25 points better (P = .001), and flexion was 5.0 degrees greater (P = .043) in the kinematically aligned group than in the mechanically aligned group.Our findings suggest that the risk of early failure related to limb or knee alignment should be similar in kinematic and mechanically aligned TKA. More anatomic alignment of the implant was associated with better flexion and better clinical outcome scores in the kinematically aligned group.