下肢负重位全长X线片在全膝关节置换术前准备中的价值  

Value of lower extremity weight-bearing full-length radiographs prepared before total knee arthroplasty

作　　者：黄钢勇[1] 夏军[1] 郑余泽[2] 王思群[1] 魏亦兵[1] 吴建国[1] 陈飞雁[1] 陈杰[1] 石晶晟[1] 魏礼成[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040 [2]复旦大学附属华山医院放射科,上海200040

出　　处：《国际骨科学杂志》2012年第6期404-406,416,共4页International Journal of Orthopaedics

摘　　要：目的评价全膝关节置换术(TKA)术前下肢负重位全长X线摄片对术后下肢力线重建及膝关节功能的影响。方法回顾性收集我院TKA患者共138例,男58例,女80例,平均年龄71.6岁。术前分段摄片组66例,负重位全长摄片组72例。两组患者年龄、性别、体重指数、术前膝关节原发疾病和美国膝关节协会(AKS)膝关节功能评分均无显著差别(P>0.05),均在术前进行力线分析和矫形设计,术中所有患者均不置换髌骨。两组患者至少6个月随访,比较下肢力线重建和美国膝关节协会(AKS)膝关节功能评分。结果分段摄片组和负重位全长摄片组术后随访显示,AKS膝关节功能评分和并发症发生率无显著差别(P>0.05)。分段摄片组有4例术后下肢残留畸形大于3°,负重位全长摄片组没有残留畸形大于3°病例(P<0.05)。结论 TKA术前下肢负重位全长摄片有利于全面了解下肢冠状位力线并进行手术设计,从而准确重建下肢力线,故推荐在TKA术前常规应用。Objective To evaluate the effectiveness of preoperative weight-bearing full-length （WBFL） radiographs of lower extremities in total knee arthroplasty （TKA）. Methods We retrospectively reviewed 138 cases （138 knees） of TKA in Huashan hospital, among which there were 58 males and 80 females with average age 71.6 years, 66 knees with femur combined with tibia radiographs or with regional knee radiographs （segmental group） and 72 knees with WBFL radiographs preoperatively （WBFL group）. There was no significant difference in age, sex, body mass index, primary diseases of the knees and the American Knee Society （AKS） scores before surgery among two groups （P〉0. 05）. The malalignment test and operation plan were done in all cases based on the radiographs available and all patella in this study were unresurfaced. All cases were followed up for 6 months at least, and their postoperative alignment of lower extremities with TKA and AKS scores were compared between these two groups. Results The postoperative AKS and complication rate of WBFL group was similar to that of segmental group （P〉0. 05）. The WBFL group got better postoperative mechanical alignment restored with no outliner when residual deformity of 3° varus or valgus as the marginal value while 4 knees were malaligned postoperatively beyond 3° in segmental group （P〈0. 05）. Conclusions The WBFL radiographs do work to better restore mechanical axis of the malaligned lower extremities in TKA and it should be recommended routinely preoperatively.

关 键 词：全膝关节置换 X线摄片 下肢力线 

分 类 号：R687.4[医药卫生—骨科学]