全膝关节置换术中对线技术应用现状

古尔冈; 哈里亚纳邦; 印度

doi:10.24920/004372

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全膝关节置换术中对线技术应用现状

中国医学科学杂志（英文） 2024年39卷第3期页码：217-225

综述 | Updated：2025-03-07

- 全膝关节置换术中对线技术应用现状
- Affiliations：
  
  Department of Orthopedics, Fortis Hospital, Gurgaon, Haryana, India
- Author bio：
  
  E-mail: hemantadhungana@gmail.com
- Funds：
- DOI：10.24920/004372
  中图分类号：
- 收稿日期：2024-04-30，
  
  录用日期：2024-07-02，
  
  网络出版日期：2024-08-05，
  
  纸质出版日期：2024-09-30
- Accepted：
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古尔冈,哈里亚纳邦,印度.全膝关节置换术中对线技术应用现状[J]. 中国医学科学杂志（英文）,2024,39(03):217-225.

Dhungana Hemanta,Jangid Subhash,Goyal Meghal.Alignment Techniques in Total Knee Arthroplasty: Where do We Stand Today?[J].Chinese Medical Sciences Journal,2024,39(03):217-225.
古尔冈,哈里亚纳邦,印度.全膝关节置换术中对线技术应用现状[J]. 中国医学科学杂志（英文）,2024,39(03):217-225. DOI： 10.24920/004372.

Dhungana Hemanta,Jangid Subhash,Goyal Meghal.Alignment Techniques in Total Knee Arthroplasty: Where do We Stand Today?[J].Chinese Medical Sciences Journal,2024,39(03):217-225. DOI： 10.24920/004372.

摘要

在全膝关节置换术中，最佳对线对确保手术成功和植入物长期存活至关重要。传统上，采用机械对线方法以达到中性对位。随着运动学对线，以及调整机械对线、受限运动学对线、反向运动学对线和功能性对线等混合技术的涌现，使复原关节运动学和解剖学对线成为可能，从而达到更好的功能性治疗效果和患者满意度。在制定最佳对线策略时必须考虑以下因素：植入物的长期耐久性、功能改善程度以及个体关节的解剖变异。此外，计算机或机器人辅助技术在手术中的应用，提高了植入体定位的精确性，实现了对软组织平衡的客观评估。在优化对线策略时，外科医生更关注满足个体解剖变异的个性化需求。目前，全膝关节置换术中应用的各种对线技术主要包括机械对线、患者个体化的运动学对线、混合对线等。本文从各种对线技术产生的的理论依据，及其手术原则和优缺点等几个方面做一综述，以帮助外科医生进一步了解这些对线技术及其疗效，选择更合理的对线方案，以改善疗效和延长植入体的使用寿命。

Abstract

Achieving optimal alignment in total knee arthroplasty (TKA) is a critical factor in ensuring optimal outcomes and long-term implant survival. Traditionally

mechanical alignment has been favored to achieve neutral post-operative joint alignment. However

contemporary approaches

such as kinematic alignments and hybrid techniques including adjusted mechanical

restricted kinematic

inverse kinematic

and functional alignments

are gaining attention for their ability to restore native joint kinematics and anatomical alignment

potentially leading to enhanced functional outcomes and greater patient satisfaction. The ongoing debate on optimal alignment strategies considers the following factors: long-term implant durability

functional improvement

and resolution of individual anatomical variations. Furthermore

advancements of computer-navigated and robotic-assisted surgery have augmented the precision in implant positioning and objective measurements of soft tissue balance. Despite ongoing debates on balancing implant longevity and functional outcomes

there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations. This review evaluates the spectrum of various alignment techniques in TKA

including mechanical alignment

patient-specific kinematic approaches

and emerging hybrid methods. Each technique is scrutinized based on its fundamental principles

procedural techniques

inherent advantages

and potential limitations

while identifying significant clinical gaps that underscore the need for further investigation.

关键词

Keywords

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