全膝关节置换术中胫骨假体旋转对线标志的影像学研究  

Imageological study of rotational alignment reference landmarks of the proximal tibia in total knee arthroplasty

作　　者：赵宝辉[1] 陈百成[2] 王聪[1] 邓默[1] 任宝[1] 徐佳丽[1] 高文山[1] 

机构地区：[1]河北大学附属医院关节骨科,保定071000 [2]河北医科大学第三医院关节骨科

出　　处：《中华骨科杂志》2012年第9期872-875,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨胫骨假体旋转对线标志在全膝关节置换术中的定位作用°方法15名健康成年志愿者，男10名，女5名；年龄21-38岁，平均（28．1±6．0）岁°行膝关节完全伸直位CT横断面扫描，26幅CT扫描图像纳入研究°在CT扫描图像上描绘两条胫骨前后轴线：后十字韧带止点中点分别与髌韧带止点处内侧缘及髌韧带中内1／3点连线，股骨外科髁上轴线；测量两条胫骨前后轴线分别与股骨外科髁上轴垂线的夹角，并与理想的胫骨假体旋转对线标志即0°进行比较°结果股骨外科髁上轴垂线与后十字韧带止点中点与髌韧带止点处内侧缘连线的夹角为-5．1°-5．8°．平均0．7°±2．8°，与0°比较差异无统计学意义；与后十字韧带止点中点与髌韧带中内1／3点连线的夹角为一3．4°～14．1°，平均6．9°±5.3°，与0°比较差异有统计学意义°两条胫骨前后轴线与股骨外科髁上轴垂线的夹角比较差异有统计学意义。结论胫骨假体旋转对线可参考后十字韧带止点中点与髌韧带止点处内侧缘连线，使股骨与胫骨假体间旋转对线更匹配。Objective To investigate the role of rotational alignment reference landmarks of the proximal tibia in total knee arthroplasty. Methods Fifteen healthy adult volunteers were enrolled in this study, including 10 males and 5 females, aged from 21 to 38 years （average, 28.1＋6.0）. CT scans of 26 knees were taken as the knees were placed in full extension. Two anteroposterior axes were drawn on the CT im-ages： one line connected the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon, and another line connected the middle of the posterior cruciate ligament insertion site and the middle-medial 1/3 of the patellar tendon. The surgical epicondylar axis was also drawn on the CT images. Angles were measured between a line perpendicular to the surgical epicondylar axis and the two an- teroposterior axes, and the angles were compared with the ideal tibial rotational alignment reference axis （0°）. Results Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon averaged 0.70±2.8° （range, -5.1°-5.8°）, there was no significant difference compared with 0°. Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior erueiate lig-ament insertion site and the middle-medial 1/3 of the patellar tendon averaged 6.90±5.3° （range, -3.4°- 14.1°）, there was significant difference compared with 0°. Significant difference existed in angles between the two anteroposterior axes and the line perpendicular to the surgical epicondylar axis. Conclusion The line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar ten- don is a more reliable reference axis for the tibial component rotational alignment, which makes the femoral and tibial components in a more matching rotational position.

关 键 词：关节成形术 置换 膝 体层摄影术 X线计算机 图像处理 计算机辅助 

分 类 号：R687.4[医药卫生—骨科学]