目的

探讨全膝关节置换术（TKA）中前髁预截骨髓外定位技术的可行性和安全性。

方法

2022年1月至2022年12月在宿迁第三医院行初次TKA手术治疗的膝关节晚期骨关节炎（OA）共160 名患者，被随机分成A 组和B 组，A 组为股骨前髁预截骨髓外定位组，B 组为传统股骨髓内定位组。去除随访小于12 个月的病例，最终A 组68 例，B 组67 例。评估2 组患者的性别、年龄、体重指数（BMI）、左右侧、术前疼痛视觉模拟评分（VAS）、术前膝关节活动度、术前西安大略和曼彻斯特大学骨关节炎指数（WOMAC）和牛津膝关节评分（OKS）的差异，比较2 组手术时间、术后引流量、股骨前皮质过度切割发生率以及术后的髋膝踝角（HKA）、胫股角（TFA）、股骨假体屈曲角（FFA）、胫骨平台后倾角（PTS）、胫骨近端内侧角（MPTA）、术后并发症率和术后1 个月、6 个月、12 个月的VAS 评分、膝关节活动度、WOMAC、OKS 并进行统计学分析。

结果

2 组间患者的性别、年龄、BMI、左右侧、术前VAS 评分、术前膝关节活动度、术前WOMAC、OKS的差异无统计学意义（P＞0.05）；A 组股骨前皮质过度切割发生率（5.9%）明显小于B 组（17.9%），组间差异有统计学意义（P＜0.05）；A 组术后引流量（248.9±49.8）ml 少于B 组（378.9±43.7）ml且差异有统计学意义（P＜0.05）；2 组间手术时间、术后并发症率以及术后测得的HKA、TFA、FFA、PTS、MPTA 差异无统计学意义（P＞0.05），A 组术后1 个月VAS 评分、膝关节活动度、WOMAC、OKS 明显优于B 组（P＜0.05），但2 组患者的术后6 个月、12 个月的VAS 评分、膝关节活动度、WOMAC、OKS 差异无统计学意义（P＞0.05）。

结论

前髁预截骨髓外定位技术安全有效，较髓内定位，可显著减少术后引流量并降低股骨前皮质过度切割发生率，在术后1 月内的疼痛缓解、关节功能和活动度方面也具备优势。

Objective

To investigate the feasibility and safety of extramedullary reference with anterior femoral condyle pre-osteotomy technique in total knee arthroplasty （TKA）.

Methods

A total of 160 patients with advanced knee osteoarthritis （OA） who underwent primary TKA at Suqian Third Hospital from January 2022 to December 2022 were randomly divided into two groups： A and B. In group A， a new extramedullary reference technique was adopted while in group B， standard intramedullary femoral instruments were used. Excluding cases with a follow-up duration less than 12 months， there were 68 cases in group A and 67 cases in group B. Gender， age， body mass index （BMI）， affected side， preoperative Visual Analogue Scale （VAS） score， preoperative range of motion （ROM）， preoperative Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）， and preoperative Oxford Knee Score （OKS） were evaluated in the two groups. Operation time， postoperative drainage volume， incidence of notching of anterior femoral cortex， postoperative hip-knee-ankle （HKA）， tibiofemoral angle （TFA）， femoral flexion angle （FFA），posterior tibial slope （PTS）， and proximal tibia medial angle （MPTA）， and postoperative complication rate were compared between the two groups， and VAS score， knee ROM， and WOMAC and OKS at 1， 6， and 12 months after operation were analyzed.

Results

There were no significant differences in gender， age， BMI，sides， preoperative VAS score， preoperative ROM， and preoperative WOMAC and OKS between the two groups （P＞0.05）. The incidence of anterior femoral cortex notching in group A （5.9%） was significantly lower than that of group B （17.9%； P＜0.05）. The postoperative drainage volume of group A ［（248.9±49.8） ml］was significantly less than that of group B ［（378.9±43.7） ml； P＜0.05］. There were no significant differences in operation time， postoperative complication rate， HKA， TFA， FFA， PTS， and MPTA between the two groups （P＞0.05）. The VAS score， ROM， WOMAC， and OKS in group A were significantly better than those of group B at 1 month after operation （P＜0.05）. However， no significant differences were found between the two groups at 6 and 12 months of follow-up （P＞0.05）.

Conclusion

The new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in TKA is safe and effective. Compared with the intramedullary alignment system， the new technique not only reduces postoperative drainage volume and the incidence of nothing of anterior femoral cortex， but it is also associated with more pain relief and better joint function and ROM within 1 month after operation.