中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (4): 612-618.doi: 10.12307/2022.975

• 骨与关节综述 bone and joint review • 上一篇    下一篇

全膝关节置换假体植入的最佳角度选择

徐祥钧1，王  超2，宋群山1，李冰言3，张吉超4，王国栋1，董跃福1   

  1. 1徐州医科大学附属连云港医院，江苏省连云港市   222000；2锦州医科大学，辽宁省锦州市   121001；3南京医科大学连云港临床学院，江苏省连云港市   222000；4上海工程技术大学材料工程学院，上海市   201620
  • 收稿日期:2022-01-04 接受日期:2022-02-11 出版日期:2023-02-08 发布日期:2022-06-23
  • 通讯作者: 董跃福，博士，副主任医师，硕士生导师，徐州医科大学附属连云港医院，江苏省连云港市 222000
  • 作者简介:徐祥钧，男，1992年生，江苏省人，汉族，徐州医科大学在读硕士，主要从事骨与关节外科方面的研究。
  • 基金资助:
    国家自然科学基金资助项目(31670956)，项目负责人：董跃福；连云港市卫生健康面上科技项目(202101)，项目 负责人：董跃福

Optimal angle for prosthesis implantation in total knee arthroplasty

Xu Xiangjun1, Wang Chao2, Song Qunshan1, Li Bingyan3, Zhang Jichao4, Wang Guodong1, Dong Yuefu1   

  1. 1Affiliated Hospital of Lianyungang, Xuzhou Medical University, Lianyungang 222000, Jiangsu Province, China; 2Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China; 3Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, Jiangsu Province, China; 4School of Materials Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
  • Received:2022-01-04 Accepted:2022-02-11 Online:2023-02-08 Published:2022-06-23
  • Contact: Dong Yuefu, MD, Associate chief physician, Master’s supervisor, Affiliated Hospital of Lianyungang, Xuzhou Medical University, Lianyungang 222000, Jiangsu Province, China
  • About author:Xu Xiangjun, Master candidate, Affiliated Hospital of Lianyungang, Xuzhou Medical University, Lianyungang 222000, Jiangsu Province, China
  • Supported by:
    This study was supported by the National Natural Science Foundation of China, No. 31670956 (to DYF); Lianyungang City Health Science and Technology Project, No. 202101 (to DYF)

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摘要：

文题释义：
全膝关节置换：用人工假体取代已严重损坏的膝关节骨性结构，从而消除疼痛、矫正畸形，恢复膝关节稳定性和活动度，常用于经保守治疗无效的晚期膝关节病变。
全膝关节置换的机械学对齐标准：分别以股骨、胫骨解剖轴为基准线，重建一条垂直于下肢机械轴的关节线，使股骨头中心与踝关节中心连线经过膝关节中心，令载荷均匀分布在膝关节假体的内外侧。

背景：膝关节的运动是三维空间的运动，具有3个平移自由度和3个旋转自由度，全膝关节置换在假体植入时要充分考虑到冠状面的内外翻角度、矢状面的前后倾角度和轴状面的内外旋角度。
目的：对全膝关节置换中股骨和胫骨假体植入角度的临床优缺点展开综述，为全膝关节置换中假体的有效植入提供参考。
方法：由第一作者应用计算机检索PubMed数据库和知网数据库中关于全膝关节置换假体植入方面的文献。英文检索词包括“total knee arthroplasty，total knee replacement，femoral，tibial，coronal，sagittal，axial，prosthesis，component，alignment，osteotomy”，中文检索词包括“全膝关节置换术，股骨，胫骨，假体，截骨，冠状面，矢状面，轴状面，力线”。将符合检索词的文章进行初筛，保留与综述内容相关且具有假体植入角度临床优缺点分析的相关文献，进一步详细分析、归纳并总结。
结果与结论：①在股骨冠状面，通过下肢负重位全长片测量下肢机械轴与股骨解剖轴之间的夹角作为股骨截骨的参考，常取4°-6°外翻截骨，将假体垂直于机械轴植入；②在股骨矢状面，为获得良好的屈膝功能，常取0°-3°前倾截骨，将假体稍微前倾植入；③在股骨轴状面，虽然外科经髁轴被认为是股骨远端的旋转中心，但手术器械在使用时参照后髁轴更方便，将假体相对于后髁轴外旋2°-5°植入；④在胫骨冠状面，为获得伸直位的矩形间隙和水平的关节线，应垂直于胫骨机械轴植入假体；⑤在胫骨矢状面，聚乙烯垫片自带一定后倾角度，常将假体后倾0°-7°植入；⑥在胫骨轴状面，因Akagi线与胫骨前后轴近似平行，常将假体前后轴与Akagi线平行植入。

https://orcid.org/0000-0001-5556-5672 (徐祥钧)

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: 全膝关节置换术, 假体植入, 精确截骨, 冠状面, 矢状面, 轴状面

Abstract: BACKGROUND: The motion of the knee joint is a three-dimensional motion with three translational degrees of freedom and three rotational degrees of freedom. When the prosthesis is implanted in total knee arthroplasty, the varus angle of the coronal plane, the anteroposterior angle of the sagittal plane and the rotation angle of the axial plane should be fully considered.  
OBJECTIVE: To summarize the clinical advantages and disadvantages of femoral and tibial prosthesis implantation angle in total knee arthroplasty, so as to provide reference for effective prosthesis implantation in total knee arthroplasty.
METHODS:  The first author searched the literature on prosthesis implantation in PubMed database and CNKI database by computer. The English key words were “total knee arthroplasty, total knee replacement, femoral, tibial, coronal, sagittal, axial, prosthesis, component, alignment, osteotomy”. The Chinese key words were “total knee arthroplasty, femur, tibia, prosthesis, osteotomy, coronal, sagittal, axial, alignment”. The articles that meet the search terms are preliminarily screened, and the relevant articles related to the review content and the clinical advantages and disadvantages of prosthesis implantation are retained for further detailed analysis, induction and summary.  
RESULTS AND CONCLUSION: (1) On the coronal plane of the femur, the angle between the mechanical axis of the lower limb and the anatomical axis of the femur is measured through the full-length film of the weight-bearing position of the lower limb as a reference for femoral osteotomy. The 4-6° valgus osteotomy is often taken, and the prosthesis is implanted perpendicular to the mechanical axis. (2) In the sagittal plane of the femur, to obtain good knee flexion function, the 0-3°anteversion osteotomy is often taken and the prosthesis is implanted slightly anteversion. (3) In the axial plane of the femur, although surgical transepicondylar axis is regarded as the rotation center of the distal femur, it is more convenient to refer to posterior condylar axis when using surgical instruments, and the prosthesis is rotated 2-5° outward relative to posterior condylar axis. (4) In the coronal plane of the tibia, to obtain the rectangular space and horizontal joint line in the extended position, the prosthesis should be implanted perpendicular to the mechanical axis of the tibia. (5) In the sagittal plane of the tibia, the polyethylene gasket has a certain retroversion angle, and the prosthesis is often implanted with a retroversion of 0-7°. (6) In the axial plane of the tibia, because the Akagi line is approximately parallel to the anterior and posterior axis of the tibia, the anterior and posterior axis of the prosthesis is often implanted parallel to the Akagi line.

Key words: total knee arthroplasty, prosthesis implantation, precise osteotomy, coronal plane, sagittal plane, axial plane

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