全膝关节置换术中不同胫骨假体旋转对线方法的研究进展

doi:10.3969/j.issn.1000-8535.2024.08.003

摘要/Abstract

摘要： 全膝关节置换术（TKA）是目前治疗终末期膝关节疾病的首选方法,它能够缓解疼痛、改善畸形、恢复力线、增加膝关节活动度及提高患者生活质量。目前,关于胫骨假体旋转对线的方法很多,主要包括胫骨结节、胫骨前后轴、胫骨前皮质、自我形合技术、计算机辅助导航技术、个性化截骨技术等,它们各有优缺点,但在临床上并没有达成共识。该文主要对胫骨近端的解剖学特点和TKA中胫骨假体旋转定位的方法等方面进行综述。旨在为临床骨科医生在行TKA时,选择合适的胫骨假体旋转对线方法提供一些参考。

关键词: 全膝关节置换术, 旋转对线, 胫骨假体, 解剖学

Abstract: Total knee replacement（TKA） is currently the preferred treatment for end-stage knee disease,and it can relieve pain,improve deformity,restore strength lines,increase knee range of motion,and improve patients’ quality of life．At present,there are many methods for the rotation of alignment of tibial prosthesis,mainly including tibial tubercles,tibial anteroposterior axes,anterior tibial cortex,self-morphing technology,computer-aided navigation technology,personalized osteotomy technology,etc．Each of the methods above has its advantages and disadvantages,but there is no clinical consensus at present．This article mainly reviews the anatomical characteristics of the proximal tibia and the method of rotational positioning of tibial prosthesis in TKA,which aims to provide some reference for clinical orthopedic surgeons to select the appropriate tibial prosthesis rotation alignment method when performing TKA．

Key words: total knee replacement, rotate the alignment line, tibial prosthesis, anatomy

蒋联建, 刘勇, 左陈冰, 梁海波, 李书振. 全膝关节置换术中不同胫骨假体旋转对线方法的研究进展[J]. 广州医药, 2024, 55(8): 836-842.

JIANG Lianjian, LIU Yong, ZUO Chenbing, LIANG Haibo, LI Shuzhen. Research progress on different tibial prosthesis rotation alignment methods in total knee arthroplasty[J]. Guangzhou Medical Journal, 2024, 55(8): 836-842.

参考文献

[1] ZHANG L,MA C,LI H,et al.Clinical characteristics of flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty[J].Chin Med J(Engl),2023,136(23):2877-2879.
[2] 列锦弟,许立新,郑彬,等.不同麻醉方式对老年患者膝关节置换术后早期认知功能障碍的影响[J].广州医药,2019,50(6):1-6,28.
[3] 沙明,李慧锋,马松鹤,等.透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者的疗效[J].广州医药,2023,54(1):44-47,55.
[4] HO J P Y,PARK S Y,NAM H S,et al.The use of an anatomic tibial baseplate in total knee arthroplasty optimizes coverage without compromising rotation:A propensity-matched evaluation[J].Knee,2023(45):35-45.
[5] CAMPANACCI L,ALì N,CASANOVA J M,et al.Resurfaced allograft-prosthetic composite for proximal tibial reconstruction in children:intermediate-term results of an original technique[J].J Bone Joint Surg Am,2015,97(3):241-250.
[6] HERNáNDEZ-HERMOSO J A,NESCOLARDE L,YAñEZ-SILLER F,et al.Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome[J].J Orthop Traumatol,2023,24(1):40.
[7] ELKINS J M,JENNINGS J M,JOHNSON R M,et al.Component rotation in well-functioning,gap balanced total knee arthroplasty without navigation[J].J Arthroplasty,2023,38(6S):S204-S208.
[8] HEGDE V,KENDALL J,SCHABEL K,et al.The James A.rand young investigator’s award:Increased revision risk with mobile bearings in total knee arthroplasty:An analysis of the American joint replacement registry[J].J Arthroplasty,2023,38(7 Suppl 2):S3-S8.
[9] JANG E S,CONNORS-EHLERT R,LIARNO S,et al.Accuracy of reference axes for femoral component rotation in total knee arthroplasty:Computed tomography-based study of 2,128 femora[J].J Bone Joint Surg Am,2019,101(23):e125.
[10] LUO J W,YU B,QIN C H,et al.Measurement of rotational alignment of the distal femur in total knee arthroplasty[J].Orthop Surg,2009,1(3):203-206.
[11] DONEGAN D J,SEIGERMAN D A,YOON R S,et al.Gerdy’s tubercle:the lighthouse to the knee[J].J Orthop Trauma,2015,29(2):e51-e53.
[12] MAKARAM N S,PARAM A,CLEMENT N D,et al.Primary versus secondary total knee arthroplasty for tibial plateau fractures in patients aged 55 or over-a systematic review and meta-analysis[J].J Arthroplasty,2024,39(2):559-567.
[13] KOH Y G,NAM J H,CHUNG H S,et al.Morphometric study of gender difference in osteoarthritis posterior tibial slope using three-dimensional magnetic resonance imaging[J].Surg Radiol Anat,2020,42(6):667-672.
[14] YUAN B,MO Z,ZHANG K,et al.The effect of different posterior inclinations of tibial component on tibiofemoral contact pressures after unicompartmental knee arthroplasty[J].J Orthop Surg Res,2023,18(1):909.
[15] INSALL J N,BINAZZI R,SOUDRY M,et al.Total knee arthroplasty[J].Clin Orthop Relat Res,1985,(192):13-22.
[16] ZHANG H,CAO C,ZHANG H,et al.Determining the rotational alignment of the tibial component referring to the tibial tubercle during total knee arthroplasty:the tibial tubercle-trochlear groove can be an aid[J].J Orthop Surg Res,2022,17(1):253.
[17] JANG E S,DAVIGNON R,GELLER J A,et al.Reference axes for tibial component rotation in total knee arthroplasty:Computed tomography-based study of 1,351 tibiae[J].J Bone Joint Surg Am,2023,105(1):1-8.
[18] 赵旻暐,田华,曾琳等.中国人采用胫骨结节及胫前肌腱定位的髓外截骨法术后胫骨假体冠状位力线的测量与分析[J].北京大学学报(医学版),2016(48):351-355.
[19] LAWRIE C M,NOBLE P C,ISMAILY S K,et al.The flexion-extension axis of the knee and its relationship to the rotational orientation of the tibial plateau[J].J Arthroplasty,2011,26(6 Suppl):53-58.e1.
[20] KOUR R Y N,GUAN S,DOWSEY M M,et al.Kinematic function of knee implant designs across a range of daily activities[J].J Orthop Res,2023,41(6):1217-1227.
[21] LU Y,REN X,LIU B,et al.Tibiofemoral rotation alignment in the normal knee joints among Chinese adults:a CT analysis[J].BMC Musculoskelet Disord,2020,21(1):323.
[22] LEE Q J,CHANG W Y E,WONG Y C,et al.Mid-term survivorship of fixed bearing unicondylar knee arthroplasty with no exclusion of early PFJ arthritis or ACL deficiency:Analysis of clinical and radiological predictors[J].J Orthop Surg(Hong Kong),2022,30(3):10225536221141782.
[23] NEDOPIL A J,ZAMORA T,DELMAN C,et al.Which asymmetric tibial component is optimally designed for calipered kinematically aligned total knee arthroplasty?[J].J Knee Surg,2022,35(14):1610-1618.
[24] SHUKLA S,UPADHYAYA V,GOEL M,et al.Antero-posterior axis of tibia in patient undergoing total knee replacement in Indian population[J].J Clin Orthop Trauma,2019,10(1):96-101.
[25] SHEKHAR A,CHOWDHRY M,SUBRAMANIAM D,et al.CT scan analysis of implant mating comparing APA versus TEA in simultaneous bilateral TKA:One technique per knee[J].Knee,2023(43):89-96.
[26] AKAGI M,OH M,NONAKA T,et al.An anteroposterior axis of the tibia for total knee arthroplasty[J].Clin Orthop Relat Res,2004(420):213-219.
[27] YIKE D,TIANJUN M,HEYONG Y,et al.Different rotational alignment of tibial component should be selected for varied tibial tubercle locations in total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2022,30(9):3061-3067.
[28] POPESCU R,HARITINIAN E G,CRISTEA S,et al.Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement[J].Int Orthop,2020,44(1):119-128.
[29] KIM J I,JANG J,LEE K W,et al.Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty[J].BMC Musculoskelet Disord,2017,18(1):252.
[30] NISHIKAWA K,MIZU-UCHI H,OKAZAKI K,et al.Accuracy of proximal tibial bone cut using anterior border of tibia as bony landmark in total knee arthroplasty[J].J Arthroplasty,2015,30(12):2121-2124.
[31] HUANG F,HARRIS S,ZHOU T,et al.Which method for femoral component sizing when performing kinematic alignment TKA?An in silico study[J].Orthop Traumatol Surg Res,2023:103769.
[32] PONGKUNAKORN A,JANTHARAGSARANGSEE T,TRIAMSASITHORN P.Anterior cortical line of femur and tibia is more accurate than mid-shaft line to determine knee extension angle relative to sagittal mechanical axis during total knee arthroplasty[J].J Orthop Sci,2024,29(3):867-873.
[33] TER WEE M A,DOBBE J G G,BUIJS G S,et al.Load-induced deformation of the tibia and its effect on implant loosening detection[J].Sci Rep,2023,13(1):21769.
[34] TSUKEOKA T,TSUNEIZUMI Y,LEE T H.Accuracy of the second metatarsal as a landmark for the extramedullary tibial cutting guide in total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2014,22(12):2969-2974.
[35] BILGEN O,BILGEN S,ERMUTLU C,et al.The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment[J].Acta Orthop Traumatol Turc,2014,48(3):271-275.
[36] SAHIN N,ATıCı T,ÖZTÜRK A,et al.Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(3):565-570.
[37] DREXLER M,BACKSTEIN D,STUDLER U,et al.The medial border of the tibial tuberosity as an auxiliary tool for tibial component rotational alignment during total knee arthroplasty(TKA)[J].Knee Surg Sports Traumatol Arthrosc,2017,25(6):1736-1742.
[38] JIN Y,LI P,YANG Y,et al.A New reference axis for tibial component rotation in total knee arthroplasty:A three-dimensional computed tomography analysis[J].Front Surg,2022(9):872533.
[39] SAHIN N,ATıCı T,KURTOĞLU Ü,et al.Centre of the posterior cruciate ligament and the sulcus between tubercle spines are reliable landmarks for tibial component placement[J].Knee Surg Sports Traumatol Arthrosc,2013,21(10):2384-2391.
[40] MARTIN S,SAUREZ A,ISMAILY S,et al.Maximizing tibial coverage is detrimental to proper rotational alignment[J].Clin Orthop Relat Res,2014,472(1):121-125.
[41] RHEE S J,CHO J Y,JEUNG S H,et al.Combined rotational alignment change after total knee arthroplasty in different tibial component designs:Implications for optimal tibial component rotational alignment[J].Knee Surg Relat Res,2018,30(1):74-83.
[42] IKEUCHI M,YAMANAKA N,OKANOUE Y,et al.Determining the rotational alignment of the tibial component at total knee replacement:a comparison of two techniques[J].J Bone Joint Surg Br,2007,89(1):45-49.
[43] SAIKI Y,KABATA T,OJIMA T,et al.Machine learning algorithm to predict worsening of flexion range of motion after total knee arthroplasty[J].Arthroplast Today,2022(17):66-73.
[44] FECZKO P Z,PIJLS B G,VAN STEIJN M J,et al.Tibial component rotation in total knee arthroplasty[J].BMC Musculoskelet Disord,2016(17):87.
[45] 安浩铭,平航宇,李海峰,等.国产“鸿鹄”骨科手术机器人辅助与传统人工全膝关节置换术近期疗效比较研究[J].中国修复重建外科杂志,2023,37(4):404-409.
[46] ZHANG Y Z,LU S,ZHANG H Q,et al.Alignment of the lower extremity mechanical axis by computer-aided design and application in total knee arthroplasty[J].Int J Comput Assist Radiol Surg,2016,11(10):1881-1890.
[47] ABDELAAL A M,KHALIFA A A,et al.Total knee arthroplasty post-high tibial osteotomy,results of an early experience from a North African arthroplasty unit,and a comprehensive review of the literature[J].J Orthop Surg Res,2023,18(1):705.
[48] SOTOZAWA M,KUMAGAI K,YAMADA S,et al.Patient-specific instrumentation for total knee arthroplasty improves reproducibility in the planned rotational positioning of the tibial component[J].J Orthop Surg Res,2022,17(1):403.
[49] STRONACH B M,PELT C E,ERICKSON J A,et al.Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment[J].J Arthroplasty,2014,29(9):1705-1708.
[50] VOLETI P B,HAMULA M J,BALDWIN K D,et al.Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty[J].J Arthroplasty,2014,29(9):1709-1712.
[51] SASSOON A,NAM D,NUNLEY R,et al.Systematic review of patient-specific instrumentation in total knee arthroplasty:new but not improved[J].Clin Orthop Relat Res,2015,473(1):151-158.
[52] MANNAN A,SMITH T O,SAGAR C,et al.No demonstrable benefit for coronal alignment outcomes in PSI knee arthroplasty:A systematic review and meta-analysis[J].Orthop Traumatol Surg Res,2015,101(4):461-468.
[53] BATAILLER C,GICQUEL T,BOUGUENNEC N,et al.A predictive score of high tibial osteotomy survivorship to help in surgical decision-making:the SKOOP score[J].Arch Orthop Trauma Surg,2023,143(8):4843-4851.
[54] YAN Y J,JIA G,BAI D W,et al.Value of personalized osteotomy in primary total knee arthroplasty for severe varus knee osteoarthritis[J].Zhongguo Gu Shang ,2023,36(4):386-392.
[55] KOSSE N M,HEESTERBEEK P J C,SCHIMMEL J J P,et al.Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty:a randomized controlled trial[J].Knee Surg Sports Traumatol Arthrosc,2018,26(6):1792-1799.