内翻型膝关节骨性关节炎患者胫股关节扭转和胫骨假体旋转定位研究  

Tibiofemoral torsion angle and axis for tibial component alignment in varus osteoarthritic knees

作　　者：史博 孙振辉[2] 杨涛 张建平 徐宏刚 王乐庆 王训 

机构地区：[1]甘肃省泾川县人民医院骨科,744300 [2]天津市人民医院关节外科,300000

出　　处：《中国矫形外科杂志》2013年第23期2339-2344,共6页Orthopedic Journal of China

摘　　要：[目的]探讨国人内翻型膝关节骨性关节炎患者胫股关节扭转角和最佳胫骨假体旋转定位方法。[方法]回顾分析2012年12月~2013年5月收治的内翻型膝关节骨性关节炎患者65例(65膝),男5例,女60例,年龄(69.03±7.24)岁,左下肢30例,右下肢35例。所有患者均进行双下肢负重全长X线和膝关节CT检查。采用RadiAnt软件测量髋-膝-踝角(HKA)、胫股解剖角(TFA),CT测量指标包括股骨后髁角(PCA)、胫股关节扭转角(Akagi角)、胫骨结节内1/3点和后交叉韧带(PCL)切迹中点连线与股骨外科外上髁轴(STEA)胫骨投射线垂线成角(1/3 TT角)以及STEA胫骨投射线垂线分割髌韧带的比值(PT比值),对影像学指标进行统计分析。[结果]65例患者HKA平均(170.76±4.55)°,TFA平均(2.44±4.17)°。CT测量PCA平均为(1.29±1.95)°(-3.10°~5.20°)。Akagi角平均(-2.91±4.03)°(-13.00°~5.40°),Akagi轴相对STEA胫骨投射线垂线处于内旋状态。1/3 TT角平均(6.24±4.23)°(-5.10°~16.70°),胫骨结节内1/3点和PCL切迹中点连线相对于STEA胫骨投射线垂线成外旋状态。PT比值平均(25.11±12.27)%(0~60.92%)。Akagi角、1/3 TT角、PT比值和HKA均无明显线性相关关系(P>0.05)。[结论]国人内翻型膝关节骨性关节炎患者胫股扭转角平均内旋2.91°。Akagi轴和胫骨结节内1/3定位确定胫骨假体外旋均不适合国人,国人TKA术中参考截骨平面髌韧带内1/4点(内侧髌韧带平均长6.75 mm)至PCL切迹中点可作为胫骨旋转定位的可靠方法。[Objective] The purpose of this study was to measure the tibiofemoral torsion deformity in varus knee osteoarthritic Chinese patients and to evaluate the accurate rotational reference for tibia prosthesis placement.[Methods] We evaluated computed tomographic(CT) scans and conventional radiographs of 65 patients(5 men,60 women) with varus osteoarthritis of the knee.Using RadiAnt software,the hip- knee- ankle angle(HKA) and the tibiofemoral angle(TFA) were measured from radiographs.RadiAnt software was also used on CT slices to measure the tibiofemoral joint torsion angle(TFTA),which includes the Akagi's line,1 /3 medial tibial tubercle(1 /3 TT angle),and patellar tendon ratio(PT ratio),intersected by a vertical line corresponding to the projected surgical transepicondylar axis.The relationship of the TFTA variables,including the Akagi's angle,1 /3 TT angle,and PT ratio,to the HKA were analyzed.[Results] In the 65 cases,the average HKA and TFA were(170.76±4.55) ° and(2.44±4.17) °,respectively.The PCA,Akagi's angle,and 1 /3 TT angle,measured with CT,were(1.29±1.95) °(range,- 3.10° to 5.20°),(- 2.91±4.03) °(range,- 13.00° to 5.40°),and(6.24±4.23) °(range,- 5.10° to 16.70°),respectively.The Akagi's axis was internal rotated and 1 /3 TT line external rotated corresponding to the projected surgical transepicondylar axis.The PT ratio averaged(25.11±12.27) %,with a range from0.00% to 60.92%.The Akagi's angle,1 /3 TT angle,and PT ratio had no linear correlations with the HKA angle(P>0.05).[Conclusion] The average tibiofemoral torsion angle was 2.91°in varus osteoarthritic knees of Chinese patients.The Akagi's axis and 1 /3 TT methods to determine the tibial external rotation are not suitable for Chinese patients.However,the axis from the 1 /4medial patellar tendon to the PCL center(medial patellar ligament averageof 6.75 mm) is an accurate and reliable method for correct tibia prosthesis rotational placement.

关 键 词：膝关节 胫股关节扭转角 全膝关节置换 Akagi轴 

分 类 号：R684.3[医药卫生—骨科学]