测号器确定全膝关节置换股骨假体型号与前髁内侧悬出状态的意义  

Medial anterior flange overhang related to the prosthesis selection determined by femoral sizer in total knee arthroplasty

作　　者：孙振辉[1] 李楠[2] 辛景义[2] 刘军[2] 任志帅 孙和军[2] 

机构地区：[1]天津市人民医院关节外科,300191 [2]天津市天津医院骨科

出　　处：《中华医学杂志》2016年第47期3811-3814,共4页National Medical Journal of China

摘　　要：目的 探讨全膝关节置换（TKA）测号器确定的股骨假体型号对前髁内侧悬出的影响。方法 分析2014年1月至2015年1月天津市人民医院关节外科收治的内翻型膝关节骨性关节炎患者61例（61膝），男14例，女47例；年龄（66.8±6.8）岁。采用Mimics软件建立股骨远端3D模型，模拟TKA手术并测量股骨内外髁前后径，依次采用测号器前后径法（测号器组）和外髁前后径法（外髁组）确定股骨假体型号（PFC Sigma），模拟假体安置和股骨四合一截骨，比较股骨前髁内侧覆盖不良情况。结果 股骨外髁前后径为（55.8±3.6）mm，显著小于测号器确定的股骨前后径[（57.0±3.6） mm，P〈0.05]。男性股骨远端不对称率（1.2%±0.1%）和女性（1.2%±0.2%）比较差异无统计学意义（P〉0.05）。测号器组股骨假体型号、股骨前斜、前髁中点内侧覆盖不良均显著大于外髁组（P〈0.05）。两种测号方法中男性股骨假体型号、假体前斜、前髁中点OH发生率均显著小于女性（P〈0.05）。结论 TKA采用测号器确定的股骨假体型号偏大并增加假体悬出风险。男性股骨假体前髁内侧悬出明显小于女性，但该差异与股骨远端不对称率无关。Objective To evaluate the medial anterior flange overhang related to the femoral prosthesis size determined by femoral sizer in total knee arthroplasty.Methods Sixty one cases of varus knee osteoarthritis （61 knees） were analyzed from January 2014 to January 2015, 14 males and 47 females, aged （66.8±6.8） year old. 3D models of distal femur were established by Mimics, total knee arthroplasty surgeries were simulated and the medial and lateral femoral condylar anteroposterior diameter were measured. According to the AP diameter of lateral femoral condyle （lateral condyle group） and femoral sizer （sizer group）, different size of the PFC Sigma femoral prosthesis models were imported to mimics, and the coverage of medial anterior femoral flange were compared.Results The AP diameter of lateral femoral condyle[（55.76±3.64） mm]was significantly less than the sizer group[（57.02±3.59） mm], P〈0.05. The distal femur aspect ratio for male （1.2 %±0.1%） and female （1.2%±0.1%） has no statistically difference （P〉0.05）. Femoral prosthesis sizes, the uncoverage diameter of the anterior chamfer line, midpoint of the flange in the sizer group were significantly larger than the lateral condyle group （P〈0.05）. The femoral size, overhang ratio of anterior chamfer line and midpoint of the flange in male were significantly larger than females （P〈0.05）.Conclusion The AP diameter determined by femoral sizer instrument had a tendency to larger prosthesis, and the risks of medial femoral anterior flange overhang increased. Medial anterior flange overhang in male was significantly less than female, but the difference had no correlation to the distal femur asepect ratio.

关 键 词：关节成形术 置换 膝 股骨 假体和植入物 悬出 

分 类 号：R687.4[医药卫生—骨科学]