全膝关节置换术后不明原因的疼痛:是旋转力线异常吗?
发布日期:2018-06-20 10:10:52浏览:14

转载于:骨科在线

股骨和胫骨假体旋转力线异常是导致全膝置换术(TKA)后疼痛的可能原因。新西兰北岸医院的Yong SW.等人通过对比2组TKA患者,发现发生不明原因疼痛的患者和功能良好的患者间在胫骨旋转力线、股骨旋转力线和联合旋转力线间不存在显著性差异。

该研究旨在对比TKA术后存在不明原因疼痛的患者和功能良好的患者的假体旋转力线,以及评估假体旋转力线和疼痛之间的关系。研究人员共纳入71例TKA术后伴有不明原因疼痛的患者与41例效果良好的病人进行对比。所有患者术后均行CT检查来测量假体的旋转力线。随后对两组患者进行对比。

结果显示,两组患者在股骨假体旋转力线方面不存在显著性差异[平均0.6°vs. 1.0° 外旋(ER), p=0.4],在胫骨假体旋转力线方面不存在显著性差异[平均11.2°对 9.5°内旋 (IR), p=0.3]。两组的联合旋转力线(胫骨+股骨旋转)也不存在差异(平均10.5° vs. 8.5°IR, p=0.25)。疼痛组中59%的患者胫骨假体旋转>9°内旋,在对照组中这种情况占49%。
在这个关于假体旋转的规模最大的研究中,研究人员发现疼痛组和功能良好组间在胫骨旋转力线、股骨旋转力线和联合旋转力线间不存在显著性差异。功能良好组的患者大多显示胫骨假体旋转力线更接近胫骨结节中内1/3。而疼痛组显示存在更多胫骨假体轻度内旋的病例。
原文摘要:
Unexplained painfollowing total knee arthroplasty: Is rotational malalignment the problem?
BACKGROUND:
Malrotation of tibial and femoral components is a potential source of painfollowing total knee arthroplasty (TKA). This study aimed to 1) compare componentrotation in TKA patients with unexplained pain versus a control group withwell-functioning TKAs and 2) investigate the relationship between TKA componentrotation and pain.
METHODS:
Seventyone patients with unexplained pain after primary TKA were compared to a controlcohort of 41 well functioning TKA patients. Both groups underwentpost-operative computed tomography (CT) scans to assess component rotation.Findings were compared between the painful and control TKA groups.
RESULTS:
We foundno difference in femoral component rotation between the painful and controlgroups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no difference intibial component rotation (mean 11.2° vs 9.5° internal rotation (IR), p=0.3).Also, there was no difference in combined mal-rotation (tibial+femoralrotation) between the groups (mean 10.5° vs 8.5°IR, p=0.25). Fifty-nine percentof patients in the painful group had tibial component rotation >9°IR vs 49%in the control group.
CONCLUSION:
In thelargest study yet on component rotation after TKA, we found no difference inthe incidence of tibial, femoral, or combined component mal-rotation in painfulversus well-functioning TKAs. Tibial component IR relative to the junction ofthe medial to middle thirds of the tibial tubercle appears to be common inpatients with well-functioning TKAs. The significance of slight tibial IRshould be interpreted with caution when evaluating the painful TKA. Level IIIretrospective case-control study.
文献出处:
Young SW, Saffi M, Spangehl MJ, Clarke HD.Unexplained pain following total knee arthroplasty: Is rotational malalignmentthe problem?. Knee. 2018 Mar 8. pii: S0968-0160(18)30032-2.