全膝置换术中股骨假体旋转参照轴的影像学比较研究  

Radiographic measurement study of two reference axes for rotational alignment of the femoral component in total knee arthroplasty

作　　者：储小兵[1] 吴海山[1] 祝云利[1] 徐长明[1] 陶坤[1] 周晓波[1] 

机构地区：[1]第二军医大学长征医院骨科,上海200003

出　　处：《解放军医学杂志》2006年第1期69-70,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的比较全膝置换术中确定股骨假体旋转对线的参照方法———股骨上髁轴与Whiteside′s线的准确性,旨在为国人的人工膝关节手术技术提供实验依据,以减少术后髌股关节并发症的发生率。方法选择80例正常人(年龄19～42岁,男女各半)的膝关节作为研究对象,应用螺旋CT扫描(层厚0.5mm)获取股骨远端精确的横断面图像,通过测量比较股骨上髁轴、Whiteside′s线与股骨后髁轴之间的关系,运用统计学方法分析其准确性。结果股骨上髁轴与股骨后髁轴的夹角(股骨后髁角)为男性6.7°±1.5°,女性6.4°±1.8°,Whiteside′s线与股骨后髁轴的夹角为男性7.2°±3.1°,女性7.8°±3.2°。性别之间无显著性差异(P>0.05)。结论股骨上髁轴作为股骨假体旋转对线的参照较为恒定可靠,而Whiteside′s线的变异度较大、重复性较差。国人的股骨后髁角比西方人大,术中如以股骨后髁轴外旋3°来放置股骨假体,容易出现假体内旋。Objective To compare the accuracy of two reference axes, i.e. the transepicondylar axis and the Whiteside＇s line, in determing the rotational alignment of the femoral prosthesis, in order to reduce the incidence of patellofemoral complications in total knee arthroplasty. Methods 80 normal knees of Chinese individuals were studied, including 40 men and 40 women, with mean age of 32 years （range, 19-42 years）. The images of cross sections of the distal femur were obtained by helical CT scanning （layer distance set at 0. 5mm）. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the tibia. The angles between the transepicondylar axis or the Whiteside＇s line and the posterior condylar surfaces of the femur were measured with the aid of the AutoCAD .software. Results The mean angle between the transepicondylar axis and the posterior condylar surfaces of the femur, named posterior condylar angle, was 6. 7°±1.5° for male and 6. 4°±1.8° for female. The mean angle between the Whiteside＇s line and the posterior condylar surfaces of the femur was 7. 2°±3. 1° for male and 7. 8°±3. 2° for female. No statistically significant difference was found between genders （P〉0. 05）. Conclusion Compared with the Whiteside＇s line, the trarmepicondylar axis seems to be more reliable to determine the rotational alignment of femoral component in total knee arthroplasty. The posterior femoral condylar angle of the Chinese people is larger than that of the Caucasians. If the widely used way of 3° lateral rotational orientation of the femoral component referring to the posterior condylar surfaces of the femur in total knee arthroplasty is adopted, it tends to produce internal malrotation of the femoral prosthesis after operation.

关 键 词：关节成形术 置换 膝 股骨上髁轴 whiteside’s线 体层摄影术 螺旋计算机 

分 类 号：R687.42[医药卫生—骨科学]