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。

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．

目的 探讨后稳定型全膝关节置换术患者术后股骨后髁偏距变化对早期功能的影响。方法 选取2013年1月—2016年1月我院收治的121例骨关节炎接受单侧后稳定型膝关节置换患者,记录所有患者术前与术后股骨后髁偏距,根据股骨后髁偏距变化情况分为A组(股骨后髁偏距不变或增加)与B组(股骨后髁偏距减小)。对两组患者进行至少12个月的随访,比较其骨关节炎指数评分(WOMAC)、美国膝关节协会评分(KS)、美国膝关节外科学会评分系统(HSS)及膝关节功能之间的差异。结果 术后,2组患者在前髁偏距变化、股骨假体屈曲角、胫骨后倾角、胫骨角方面差异无统计学意义(P＞0.05)。但术后1年A组患者在WOMAC评分、HSS评分和负重主动屈曲范围方面改善优于B组患者,差异有统计学意义(P＜0.05)。结论 重建股骨后髁偏距能够改善后稳定型全膝关节置换术患者术后早期的骨关节炎症状,并提升患者负重位主动屈曲范围,有一定临床价值。

Objective To explore the stabilized total knee arthroplasty effects on early functional changes of condylar offset. Methods 121 cases of posterior stabilized total knee arthroplasty in our hospital from Jan.2013 to Jan.2016 were enrolled in the study. All patients with preoperative and postoperative posterior condylar offset records, according to the changes of femoral condylar offset were divided into A group and B group. The patients in the two groups were followed for at least 12 months, and the differences in the Osteoarthritis Index score (WOMAC), the American Knee association score (KS), HSS score and knee function were compared. Results After surgery, two patients in the anterior condylar offset changes, femoral prosthesis flexion angle, tibial angle, tibial angle difference was not statistically significant (P > 0.05). But after 1 years, the improvement of WOMAC score, HSS score and weight-bearing active flexion range in group A was better than that in group B, the difference was statistically significant (P < 0.05). Conclusions The reconstruction of the posterior condylar offset can improve the stability after total knee arthroplasty in patients with early osteoarthritis symptoms, and enhance the active flexion range of patients with weight-bearing, which has some clinical value.