基于Akagi轴线对膝骨关节炎患者胫骨旋转参考轴线的相关研究  

Relative analysis of tibial rotational reference axes for osteoarthritic knees based on Akagi line

作　　者：窦勇[1] 周一新[1] 柳剑[1] 杨德金[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《中国矫形外科杂志》2015年第2期97-101,共5页Orthopedic Journal of China

摘　　要：[目的]测量国人膝骨关节炎患者在胫骨预定截骨平面上经胫骨平台几何中心点的胫骨平台最大横轴（maximal mediolateral axis）垂线、胫骨后髁连线（posterior tibial condylar line）垂线与Akagi轴线之间的夹角,以及经髌腱止点的胫骨横截面上胫骨平台中心投影点与胫骨结节中内1/3连线与Akagi轴线的夹角,并与正常人群比较。分析上述角度与冠状面下肢力线是否存在相关性。[方法]选择2011年12月-2012年12月间75例行膝关节置换的患者,术前行患侧膝关节CT扫描,共112膝,按照冠状面下肢力线进行分组,其中内翻膝（内翻组）92例,外翻膝（外翻组）20例,男18人,女57人,平均年龄（65.5±7.9）岁（45-81岁）。通过Mimics软件进行三维CT重建后,在胫骨平台下8 mm预定截骨面上经胫骨平台中心点测量胫骨最大横轴垂线及胫骨后髁连线垂线与Akagi轴线之间的夹角;测量经髌腱止点的胫骨横截面上胫骨平台中心投影点与胫骨结节中内1/3连线与Akagi轴线的夹角,并与正常人群（正常组）比较。探讨上述角度是否与性别、年龄、aLDFA、mFTA、aMPTA相关。[结果]胫骨后髁连线垂线与Akagi轴线的夹角三组间均存在差异,正常组及内翻组胫骨最大横轴垂线及胫骨平台中心投影点与胫骨中内1/3连线与Akagi轴线之间的夹角小于外翻组。[结论]按照胫骨结节中内1/3处放置假体容易使假体处于过度外旋状态,在预定截骨平面确定胫骨假体旋转时应当考虑到Akagi轴线与胫骨平台中心的关系。[Objective]To observe the angles between the Akagi line and the perpendicular line to the tibial maximal mediolateral axis,posterior tibialconlylar line passing through the center of tibial plateau on the planned cutting plane and the line connecting the projected tibial plateau center and the medial 1 /3 of the tibial tubercle on the plane of patellar tendon attachment,and to compare with normal knees. And to analyze whether these data were related with coronal alignment of the lower limb. [Method]Total 112 knees of 75 patients which underwent total knee arthroplasty from December 2011 to December 2012 were selected for preoperative CT scans. The osteoarthritic knees were divided into two groups according to coronal alignment of the lower limb. There were 92 varus knees（ varus group） and 20 valgus knees（valgus group） involved and the average age of the patients was 65. 5 ± 7. 9（45- 81） years old with 18 males and 57 females. We reconstructed three- dimensional CT images through Mimics software,measuring the angles between the Akagi line and the line perpendicular to tibial maximal mediolateral axis,posterior tibial condylar line on the planned cutting plane,the line connecting the projected tibial plateau center and medial1 /3 of the tibial tubercle on the plane of patellar tendon attachment,and compared these angles with normal knees（normal group）. We explored whether these angles were correlated with gender,age,anatomical lateral distal femoral angle（a LDFA）,mechanical femoral tibial angle（mFTA） and anatomical medial proximal tibial angle（a MPTA）. [Result]The angles between the Akagi line and the line perpendicular to the posterior tibial condylar line were different among three groups. The angles between the Akagi line and the line perpendicular to the maximal mediolateal axis and the medial 1 /3 of the tibial tubercle in normal and varus knees were smaller than in the valgus group. [Conclusion]The tibial component tends to be implanted external rotationally if referencing the med

关 键 词：胫骨旋转力线 Akagi线 胫骨最大横轴 胫骨后髁连线 胫骨结节 

分 类 号：R684.3[医药卫生—骨科学]