中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (24): 3822-3826.doi: 10.12307/2024.609

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间隙平衡器下平衡技术与测量截骨技术在全膝关节置换中的应用

黄雪黎1，罗瑞琴1，陈  晟2，李晓武2，陈海波2，曾庆强2，郑志辉2   

  1. 1广州中医药大学，广东省广州市   510006；2 广州中医药大学附属汕头市中医医院骨科，广东省汕头市   515031
  • 收稿日期:2023-06-12 接受日期:2023-07-27 出版日期:2024-08-28 发布日期:2023-11-20
  • 通讯作者: 郑志辉，硕士，副主任医师，广州中医药大学附属汕头市中医院骨科，广东省汕头市 515031
  • 作者简介:黄雪黎，女，1997年生，广东省汕尾市人，汉族，广州中医药大学在读硕士，主要从事中医骨伤科学研究。
  • 基金资助:


Application of balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty

Huang Xueli1, Luo Ruiqin1, Chen Sheng2, Li Xiaowu2, Chen Haibo2, Zeng Qingqiang2, Zheng Zhihui2   

  1. 1Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2Department of Orthopedics, Shantou Hospital of TCM, Guangzhou University of Chinese Medicine, Shantou 515031, Guangdong Province, China
  • Received:2023-06-12 Accepted:2023-07-27 Online:2024-08-28 Published:2023-11-20
  • Contact: Zheng Zhihui, Master, Associate chief physician, Department of Orthopedics, Shantou Hospital of TCM, Guangzhou University of Chinese Medicine, Shantou 515031, Guangdong Province, China
  • About author:Huang Xueli, Master candidate, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

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摘要：


文题释义：

间隙平衡技术：利用膝关节周围韧带张力，结合垂直胫骨纵轴的平台截骨以获得平衡的屈伸矩形间隙。
测量截骨技术：根据人体骨性解剖标志股骨通髁线、后髁连线和Whiteside线解剖学数据研究结果进行股骨后髁截骨，再行软组织平衡，以获得内外侧等张等大的屈伸间隙。
间隙平衡器：用于膝关节置换术中测量和维持膝关节正常间隙的器械工具，术中撑开间隙时显示所施力度、间隙宽度及内外侧平衡情况，并行股骨外旋角度设定。 


背景：目前测量截骨技术和间隙平衡技术是全膝关节置换术中最常用的技术，各有优缺点：间隙平衡技术通过调整截骨角度可以减少对软组织的松解，得到更平衡的屈伸间隙，临床效果更优，但缺乏工具的间隙平衡技术，易受术者手术经验及主观判断影响，存在更多的误差；测量截骨法学习曲线短，但依赖解剖标志，容易定位不准而出现多种并发症。近年来，许多器械公司相继研发并推出了间隙平衡工具以期提高手术质量，但目前关于该工具的相关报道仍较少。

目的：对比结合间隙平衡器的间隙平衡技术与传统测量截骨应用于全膝关节置换的临床疗效，以探究间隙平衡器在全膝关节置换过程中的应用价值。
方法：收集85例全膝关节置换患者的病历资料，根据手术方式分为2组，A组44例采用结合间隙平衡器的间隙平衡技术进行全膝关节置换；B组41例采用测量截骨技术进行全膝关节置换。比较两组患者手术时间、美国膝关节协会评分、膝关节活动度、下肢力线改变及术后并发症的发生情况，以评估结合间隙平衡器的间隙平衡技术在全膝关节置换中的应用效果。

结果与结论：①85例患者均获得随访；②两组术后膝关节活动度均较术前提高(P < 0.05)，且A组较B组改善更明显(P < 0.05)；③两组术后美国膝关节协会评分均较术前提高(P < 0.05)，且术后2周、术后1，3个月和末次随访时，A组美国膝关节协会评分高于B组同期(P < 0.05)；④手术时间A组较B组稍短，但差异无显著性意义(P > 0.05)；⑤术后两组下肢力线均较其术前改善，但两组差异无显著性意义(P > 0.05)；⑥术后A组并发症发生率(2%)较B组(7%)低，但两组差异无显著性意义(P > 0.05)；⑦提示相较于测量截骨技术，结合间隙平衡器的间隙平衡技术可提高临床效果，改善膝关节功能及活动度。

https://orcid.org/0009-0001-3631-0399 (黄雪黎)；https://orcid.org/0000-0002-8809-1247 (郑志辉) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 全膝关节置换, 测量截骨技术, 间隙平衡技术, 间隙平衡器, 骨性关节炎

Abstract: BACKGROUND: At present, measurement osteotomy technique and gap balance technique are the two main surgical methods in total knee arthroplasty. Both methods have their advantages and disadvantages. By adjusting the osteotomy angle, the gap balance technique can reduce the release of soft tissue and obtain a more balanced flexion and extension space. The clinical efficacy of gap balance technique is superior, but this surgical method lacks tools and is easily influenced by the surgeon’s surgical experience and subjective judgment, with more errors. Measurement osteotomy technique has a short learning curve, but it relies on anatomic markers and is prone to many complications due to inaccurate positioning. In recent years, many instrument companies have successively developed and launched tools that can improve the quality of surgery. However, there are still few reports about the tool. 
OBJECTIVE: To compare the clinical efficacy of gap balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty, and explore the value of Offset Repo-Tensor in total knee arthroplasty. 
METHODS: The medical records of 85 patients with total knee arthroplasty were collected and divided into two groups according to the operation method. Group A consisted of 44 patients who underwent total knee arthroplasty using a gap balance technique combined with Offset Repo-Tensor. Group B consisted of 41 patients who underwent total knee arthroplasty using measurement osteotomy technique. Surgical time, American Knee Society Score, knee range of motion, changes in lower limb alignment, and postoperative complications were compared between the two groups to evaluate the clinical efficacy of gap balance technique combined with Offset Repo-Tensors in total knee arthroplasty.
RESULTS AND CONCLUSION: (1) All 85 patients were followed up. (2) Postoperative knee range of motion in both groups was higher than that before surgery (P < 0.05), and the improvement in group A was more significant than that in group B (P < 0.05). (3) American Knee Society Score in both groups after surgery was higher than that before surgery (P < 0.05), and the American Knee Society Score in group A was higher than that in group B at 2 weeks, 1, 3 months, and the last follow-up (P < 0.05). (4) The operation time of group A was slightly shorter than that of group B, but the difference was not significant (P > 0.05). (5) The lower limb alignment in both groups was improved after operation, but there was no significant difference between the two groups (P > 0.05). (6) The complication rate of group A (2%) was lower than that of group B (7%), but there was no significant difference between the two groups (P > 0.05). (7) It is indicated that compared with the measurement osteotomy technique, the combination of Offset Repo-Tensor and gap balance technique can elevate the clinical effect and improve the function and motion range of the knee joint.

Key words: total knee arthroplasty, measurement osteotomy technique, gap balance technique, Offset Repo-Tensor, osteoarthritis

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