[1]蔡宏** 张克 赵然.改良Pie-crusting技术在初次全膝关节置换术内侧松解中的应用[J].中国微创外科杂志,2017,17(3):237-241.
　Cai Hong,Zhang Ke,Zhao Ran..Application of Modified Pie-crusting Technique in Releasing Medial Tightness During Primary Total Knee Arthroplasty[J].Chinese Journal of Minimally Invasive Surgery,2017,17(3):237-241.
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改良Pie-crusting技术在初次全膝关节置换术内侧松解中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年3期
页码:
237-241
栏目:
临床研究
出版日期:
2017-06-20

文章信息/Info

Title:
Application of Modified Pie-crusting Technique in Releasing Medial Tightness During Primary Total Knee Arthroplasty
作者:
蔡宏** 张克 赵然
北京大学第三医院骨科，北京100083
Author(s):
Cai Hong;  Zhang Ke;  Zhao Ran.
Department of Orthopedics, Peking University Third Hospital, Beijing 100083, China
关键词:
改良Pie-crusting技术; 初次全膝关节置换
Keywords:
Modified Pie-crusting technique; Primary total knee arthroplasty
文献标志码:
A
摘要:
目的评估改良Pie-crusting技术(简称PC技术)在初次全膝关节置换术（total knee arthroplasty，TKA）内侧松解中应用的安全性和有效性。方法2014年3月～2016年6月由同一术者采用改良PC技术完成膝内翻畸形初次TKA 30例（34膝）。使用特制带弧形刀柄限宽3 mm、限深5 mm的手术刀进行横行点戳，以紧张部位优先松解的原则，伸直紧时松解内侧副韧带浅层后束纤维及后内侧关节囊，屈曲紧时松解内侧副韧带浅层前束纤维。记录松解前后伸直、屈曲位内外侧间隙值；根据术中测量值分为伸直屈曲均紧张组（10膝）、仅伸直紧张组（13膝）和仅屈曲紧张组（11膝），间隙≤1 mm为软组织平衡，分别计算平衡矫正率。术后定期拍摄患膝负重位片测量下肢力线，记录膝关节活动度（range of motion，ROM）、HSS评分、WOMAC评分，并与术前比较。结果31膝达到屈伸间隙、内外侧间隙平衡。1膝伸直间隙内外侧相差2 mm，2膝屈曲间隙内外侧相差2 mm，总体平衡矫正率91.2%(31/34)。3例术中应用限制性垫片。未发生因该技术导致的其他并发症。仅伸直紧组松解后屈曲间隙增加中位数1 mm（1~3 mm），仅屈曲紧组松解后伸直间隙增加中位数1 mm（1~2 mm），无统计学差异（Z=-1.118，P=0.264）。术前患者膝关节ROM为83.3°±14.7°，机械轴偏移角度中位数11.5°（7°~32 °），HSS评分为（42.7±16.3）分、WOMAC评分为（76.2±8.2）分，术后膝关节ROM为100.7°±14.2°（t=-7.714，P=0.000）、机械轴偏移角度中位数1 °（0°~4°）（Z=-5.092，P=0.000）、HSS评分（88.1±9.9）分（t=-21.868，P=0.000）、WOMAC评分（11.4±97）分（t=31.726，P=0.000），均较术前明显改善。结论在初次TKA中使用改良PC技术做内侧松解是安全、有效的。仅松解伸直或屈曲位触摸紧张的纤维，也会同时影响两个间隙。
Abstract:
ObjectiveTo analyze and evaluate the safety and efficacy of modified Pie-crusting (PC) technique for releasing medial tightness during primary total knee arthroplasty (TKA).MethodsWe completed primary TKA by the same performer with modified PC technique in 30 patients (34 knees) with genu varus from March 2014 to June 2016. By using a special curved scalpel with width limit of 3 mm and depth limit of 5 mm to poke the tension parts, we released the anterion bondle of superficial medial collateral ligament (sMCL) and posteromedial corner structures (PMCS) during tension happened in extension, and we released the posterior bondle of sMCL during tension happened in flexion. According to the gap value measured intraoperatively, we divided these cases into three groups: extension with flexion tension group (10 knees), extension tension group (13 knees), and flexion tension group (11 knees). The difference between medial and lateral gap value no more than 1 mm was defined as gap balance. We calculated the gap balance rate of each group. Series of weighted frontal X-ray were conducted at fixed period to evaluate the varus angle of the knee postoperatively. The range of motion (ROM), HSS scores and WOMAC scores were also recorded at the same time.ResultsAmong the 34 knees, 31 knees reached the medial and lateral gap balance at both extension and flexion. There was a difference of 2 mm in medial and lateral gap value at extension in 1 knee and the same difference at flexion in the other 2 knees. The total postoperative gap balance rate was 91.2%(31/34). The constrained inserts were implanted in 3 cases. No technical-related complications happened after the surgery. After the releasing procedure, the flexion gap value had an increase of 1 mm (range, 1-3 mm) in the extension tension group, and the extension gap value had an increase of 1 mm (range, 1-2 mm) in the flexion tension group, without significant difference (Z=-1.118, P=0.264). The ROM was 83.3°±14.7° preoperatively and 100.7°±14.2° postoperatively (t=-7.714, P=0.000). The median alignment of the knee was 11.5° (range, 7°-32°) preoperatively and 1° (range, 0°-4°) postoperatively (Z=-5.092，P=0.000). The HSS scores were (42.7±16.3) points preoperatively and (88.1±9.9) points postoperatively (t=-21.868, P=0.000). The WOMAC scores were (76.2±8.2) points preoperatively and (11.4±9.7) points postoperatively (t=31.726, P=0000). All of them were significantly improved in comparison with those before the surgery. ConclusionsUsing modified PC technique is safe and effective in medial releasing during primary TKA. Both extension and flexion gap value will be affected by releasing tensed fiber at extension or flexion position.

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备注/Memo

备注/Memo:
北京市科学技术委员会基金（项目编号：D121100004212005）**通讯作者，E-mail：hongcai@bjmu.edu.cn
更新日期/Last Update: 2017-06-20