单髁置换术中不同股骨定位对术后假体力线及膝关节功能的影响OA

Objective:To explore the effects of mechanical alignment(MA)and kinematic alignment(KA)on femoral prosthesis mechanical axis and knee joint function in patients with knee osteoarthritis(KOA)undergoing unicompartmen-tal knee arthroplasty(UKA).Methods:A total of 151 patients with KOA who underwent unilateral UKA from January 2021 to January 2024 were selected and divided into the MA group(n=77)and the KA group(n=74)accord-ing to surgical technique.To balance the potential differences between the two groups,propensity score matching was used to match them at a ratio of 1∶1,resulting in 68 cases in each group.Intraoperative indicators of the two groups were compared.Repeated variance analysis was used to compare the lower limb mechanical axis before and after surgery in the two groups.Knee joint function before and after surgery in the two groups was compared.The correlation between lower limb mechanical axis indicators and knee joint function scores was analyzed by generalized additive model(GAM).Binary Log-binomial regression was used to analyze the incidence of adverse reactions in the two groups.Results:The postopera-tive drainage volume,total incision length,and length of hospital stay in the MA group were(89.45±13.11)mL,(9.19±1.11)cm,and(5.39±1.32)d,respectively,all higher than those in the KA group(80.37±13.92)mL,(8.09±0.98)cm,and(4.37±1.01)d,with statistical significance(P＜0.05).The results of repeated measures ANOVA showed that the main effects of time and group,as well as the time × group interaction effect,were statistically significant for the hip-knee-ankle angle,femoral prosthesis angle,tibial prosthesis angle,knee joint function score,knee joint stability,and knee joint proprioception(P＜0.05).The knee joint function score results showed that the HSS score,KSS joint score,KSS function score,and Lysholm score of the MA group at 6 months after surgery were(82.13±17.44),(78.96±20.88),(82.19±20.88),and(70.32±14.01)points,respectively-significantly lower than those of the KA group((88.46±18.01),(87.45±25.28),(90.59±22.32),and(76.43±15.02)points)(P＜0.05).The results of knee joint stability showed that at 6 months after surgery,the walking speed and stride of patients in the MA group were(0.70±0.16)m/s and(1.05±0.20)m,respectively-both significantly lower than those in the KA group(0.81±0.20)m/s and(1.19±0.22)m,and the difference was statistically significant(P＜0.05).The knee joint proprioception results showed that the 30°/45°/60° in the MA group at 6 months after surgery were 3.52°±0.41°,2.76°±0.39°,and 3.09°±0.28°,respectively,which were higher than those in the KA group(3.15°±0.46°,2.31°±0.46°,and 2.64°±0.53°),and the differences were statistically significant(P＜0.05).GAM results showed that the hip-knee-ankle angle,femoral prosthesis angle,and tibial prosthesis angle were linearly related to the HSS score,KSS joint score,KSS function score,and Lysholm score.Log-binomial regression showed no statistically significant difference in the risk of postoperative complications between the KA group and the MA group(P＞0.05).Conclusion:Both MA and KA guidance in UK A can improve knee joint function and stability in KO A patients after surgery,but the KA group has a better improvement effect on knee joint function.