Abstract：
OBJECTIVE: To retrospectively report on the impact of local soft tissue thickness and surgeon skill level on the accuracy of surgical posterior tibial slope (PTS) alteration achieved in patients undergoing total knee arthroplasty (TKA) utilising lateral knee radiographs.
METHODS: Pre- and postoperative radiographs of 82 patients undergoing primary TKA using conventional mechanical alignment technique were measured by two observers and subjected to quality criteria for accurate measurement of the PTS. All patients underwent a standardised surgical approach for PTS alteration: cruciate-retaining (CR) cases with preoperative PTS ≤ 10° were set for reconstruction of the preoperative PTS. Cases indicated for posterior-stabilised (PS) design and/or with a preoperative PTS > 10° were set for 3° of postoperative PTS. Pretibial subcutaneous fat (PSF) and surgeon skill level were analysed for their predictive quality regarding the accuracy of surgical PTS alteration achieved.
RESULTS: The overall mean postoperative PTS was significantly lower than the preoperative values (6.2°, SD 2.7 vs. 7.7°, SD 3.2; p = 0.002103). Neither local soft tissue thickness, namely PSF, nor surgeon skill level was found to be a predictor of the accuracy of surgical PTS alteration achieved. Among cases set for PTS reconstruction, 25.9% and 42.6% achieved a postoperative PTS within ±1° and ±2° of preoperative values, respectively. In patients with a PTS > 10° or those indicated for PS design, slope reduction was achieved with a mean postoperative PTS of 6.5°. Furthermore, 14.3% and 32.1% of cases were within ±1° and ±2° of 3, respectively.
CONCLUSIONS: This study demonstrates that accurate surgical alteration of the PTS is possible in TKA regardless of local knee soft tissue thickness or surgeon skill level. This proves the clinical feasibility of both targeted reduction as well as reconstruction of the PTS in TKA.
METHODS: Level III, retrospective cohort study.
METHODS: Pre- and postoperative radiographs of 82 patients undergoing primary TKA using conventional mechanical alignment technique were measured by two observers and subjected to quality criteria for accurate measurement of the PTS. All patients underwent a standardised surgical approach for PTS alteration: cruciate-retaining (CR) cases with preoperative PTS ≤ 10° were set for reconstruction of the preoperative PTS. Cases indicated for posterior-stabilised (PS) design and/or with a preoperative PTS > 10° were set for 3° of postoperative PTS. Pretibial subcutaneous fat (PSF) and surgeon skill level were analysed for their predictive quality regarding the accuracy of surgical PTS alteration achieved.
RESULTS: The overall mean postoperative PTS was significantly lower than the preoperative values (6.2°, SD 2.7 vs. 7.7°, SD 3.2; p = 0.002103). Neither local soft tissue thickness, namely PSF, nor surgeon skill level was found to be a predictor of the accuracy of surgical PTS alteration achieved. Among cases set for PTS reconstruction, 25.9% and 42.6% achieved a postoperative PTS within ±1° and ±2° of preoperative values, respectively. In patients with a PTS > 10° or those indicated for PS design, slope reduction was achieved with a mean postoperative PTS of 6.5°. Furthermore, 14.3% and 32.1% of cases were within ±1° and ±2° of 3, respectively.
CONCLUSIONS: This study demonstrates that accurate surgical alteration of the PTS is possible in TKA regardless of local knee soft tissue thickness or surgeon skill level. This proves the clinical feasibility of both targeted reduction as well as reconstruction of the PTS in TKA.
METHODS: Level III, retrospective cohort study.
摘要：
目的：回顾性报道局部软组织厚度和外科医生技能水平对使用膝关节外侧片进行全膝关节置换术（TKA）的患者胫骨后斜度（PTS）改变的准确性的影响。
方法：由两名观察者测量了使用常规机械对准技术进行原发性TKA的82例患者的术前和术后X线照片，并根据质量标准进行PTS的精确测量。所有患者均接受了标准化的PTS手术方法的改变：术前PTS≤10°的交叉保留（CR）病例被设置为术前PTS的重建。后稳定（PS）设计和/或术前PTS>10°的病例设定为术后PTS3°。分析了胫骨前皮下脂肪（PSF）和外科医生技能水平对手术PTS改变准确性的预测质量。
结果：术后总体平均PTS值明显低于术前（6.2°，SD2.7vs.7.7°,标准差3.2；p=0.002103)。局部软组织厚度，即PSF，也没有发现外科医生的技能水平可以预测手术PTS改变的准确性.在为PTS重建设定的病例中，25.9%和42.6%在术前±1°和±2°内达到术后PTS,分别。在PTS>10°或需要PS设计的患者中，术后平均PTS为6.5°时,斜率降低.此外，14.3％和32.1％的病例分别在3的±1°和±2°内。
结论：这项研究表明，无论膝关节局部软组织厚度或外科医生技能水平如何，在TKA中都可以对PTS进行准确的手术改变。这证明了在TKA中靶向减少和重建PTS的临床可行性。
方法：三级，回顾性队列研究。
方法：由两名观察者测量了使用常规机械对准技术进行原发性TKA的82例患者的术前和术后X线照片，并根据质量标准进行PTS的精确测量。所有患者均接受了标准化的PTS手术方法的改变：术前PTS≤10°的交叉保留（CR）病例被设置为术前PTS的重建。后稳定（PS）设计和/或术前PTS>10°的病例设定为术后PTS3°。分析了胫骨前皮下脂肪（PSF）和外科医生技能水平对手术PTS改变准确性的预测质量。
结果：术后总体平均PTS值明显低于术前（6.2°，SD2.7vs.7.7°,标准差3.2；p=0.002103)。局部软组织厚度，即PSF，也没有发现外科医生的技能水平可以预测手术PTS改变的准确性.在为PTS重建设定的病例中，25.9%和42.6%在术前±1°和±2°内达到术后PTS,分别。在PTS>10°或需要PS设计的患者中，术后平均PTS为6.5°时,斜率降低.此外，14.3％和32.1％的病例分别在3的±1°和±2°内。
结论：这项研究表明，无论膝关节局部软组织厚度或外科医生技能水平如何，在TKA中都可以对PTS进行准确的手术改变。这证明了在TKA中靶向减少和重建PTS的临床可行性。
方法：三级，回顾性队列研究。
