旋转平台全膝关节置换术中胫骨假体的旋转安放及相关研究  

Determination neutral tibial rotational alignment in rotating platform TKA

作　　者：陶坤[1] 蔡明[1] 张立国[1] 吴海山[2] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072 [2]上海长征医院骨科,上海200003

出　　处：《中国骨与关节外科》2009年第4期264-268,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：目的通过对旋转平台全膝关节置换术(total knee arthroplasty,TKA)术中胫骨假体自行确定的旋转中立位与胫骨结节内侧缘、胫骨结节中内1/3等解剖标志点相互位置关系的比较,探讨TKA术中胫骨假体的正确旋转放置位置。方法2006年3月至2008年3月,对30例患者行初次单膝关节置换术,女21例,男9例;年龄54～77岁,平均62岁。术前诊断:骨关节炎23例,类风湿关节炎7例。所有手术均采用旋转平台膝关节假体。胫骨假体的旋转放置以胫骨前后轴为参照。假体试件安装完毕、关节复位后,全范围内屈伸膝关节数次,使旋转平台在股骨假体的导引下自行确定其伸直位时的旋转中立位。借助于试件前方的刻度标志测量胫骨平台旋转试件相对于金属托中心(胫骨结节内侧缘)的旋转角度。结果胫骨旋转平台试件的中点相对于胫骨结节内侧缘的平均旋转角度为外旋2.3°±3.4°,其中男性平均为2.2°±3.6°,女性平均为2.4°±3.4°,男、女性比较差异无统计学意义。膝内、外翻平均外旋角度分别为2.9°±3.0°和1.4°±3.9°,膝内翻外旋角度大于膝外翻。本次研究的结果显著小于国人胫骨前后轴与后十字韧带中点胫骨结节中内1/3连线的夹角。结论国人TKA术中采用固定平台膝关节假体时,以胫骨结节中内1/3为标准行胫骨假体旋转放置时,有导致胫骨假体相对于股骨假体外旋过度的可能,满意的胫骨假体旋转安放位置应位于胫骨结节内侧缘稍外侧。Objective To compare the neutral rotational position determined by the rotating platform with the most medial aspect and 1/3 of the tibial tubercle in total knee arthroplasty （TKA）. Methods From March 2006 to March 2008, 30 patients who underwent unilateral TKA were enrolled in this study. There were 21 females and 9 males with an average age of 62 years old （54 - 77 years）. Of them, 23 cases had osteoarthritis and 7 cases had rheumatoid arthritis in preoperative diagnosis. All the knees used rotating platform TKA. After trial components were inserted with the knee prop-erly balanced, we recorded the neutral point of the rotating tibial insert, in extension, relative to the most medial aspect of the tibial tubercle. Divergence of the neutral point was recorded as internal or external to the medial border of the tibial tubercle to the nearest 5° increment. Results The neutral rotational position had a mean divergence of 2. 3°± 3.4° external to the medial border of the tubercle, which was typically smaller than the angle between the AP axis and the line connecting the middle of the PCL and 1/3 of the of the tibial patellar on CT. Conclusion The neutral rotational position of the tibial prostheses is close to the medial aspect of the tibial tubercle. There is a tendency to align the tibial component in external rotation relative to the femoral component when the medial 1/3 of the tibial tubercle is used.

关 键 词：全膝关节置换术 经股骨上髁轴 胫骨前后轴 

分 类 号：R687.4[医药卫生—骨科学]