股骨后髁角作为全膝置换旋转力线标志的可靠性研究  

Reliability of posterior condylar angle as femoral rotational bony land-mark in total knee replacement

作　　者：吴剑彬[1] 王逸扬[2] 周飞亚[1] 汤骏[1] 冯永增[1] 潘俊[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院骨科,浙江温州325027 [2]温州医科大学附属第二医院育英儿童医院新生儿科,浙江温州325027

出　　处：《中国现代医生》2016年第31期5-8,共4页China Modern Doctor

基　　金：浙江省温州市科技局课题(Y20090371);浙江省医药卫生科技计划项目(2011KYB052)

摘　　要：目的通过定位和测量膝关节磁共振图像上全膝置换股骨远端旋转对位标志,评价股骨后髁角做为旋转力线标志的可靠性。方法对正常膝关节进行磁共振扫描。在横断位图像上测量股骨后髁轴,以及临床经股骨通髁轴、Whiteside's线相对于外科经股骨通髁轴旋转的角度。在冠状面上测量胫骨平台内翻角。结果共测量78例正常膝关节。配对t检验提示股骨后髁角和胫骨平台内翻角之间差异无统计学意义(P>0.05),Whiteside's线的垂线相对于外科经股骨通髁轴旋转的角度和胫骨平台内翻角之间差异有统计学意义(P<0.05),临床经股骨通髁轴相对于外科经股骨通髁轴旋转的角度和胫骨平台内翻角之间差异有统计学意义(P<0.05),单样本t检验提示股骨后髁轴外旋3°和胫骨平台内翻角之间差异有统计学意义(P<0.05)。结论利用股骨后髁轴作为全膝置换术中旋转力线参考标志,较Whiteside's线和临床经股骨通髁轴更可靠。传统沿股骨后髁轴外旋3°截骨的可靠性差。股骨后髁角的变异范围大,需进行个体化医疗。Objective To assess the reliability of posterior condylar angle （PCA） as femoral rotational bony landmark in total knee replacement. Methods The coronal and traverse magnetic resonance images of knee were obtained. The fol- lowing angles were measured on traverse sections： PCA; angle between the perpendicular of Whiteside＇s APL and surgi- cal transepieondylar axis （ASA）; angle between CTEA and surgical transepicondylar axis （CSA）. The angle between the perpendicular of anatomical axis of proximal tibia and the tibial plateau tangent（ATA） was measured on coronal sections. Results All 78 normal knees of individuals were studied. Paired t-test showed that there was no significant difference between PCA and ATA（P〉0.05）. There was significant difference between ASA and ATA, and between CSA and ATA （P〈0.05）. Independent t-test showed that there was significant difference between ATA and external rotating 3° along posterior condylar line（P〈0.05）. Conclusion PCA is more reliable than CTEA and Whiteside＇s APL as femoral rotational bony landmark in total knee arthroplasty. The traditional external rotating 3° along posterior condylar line（PCL） is unre- liable. The heterogenicity of PCA is large, it is better to obtain individual PCA preoperatively.

关 键 词：全膝关节成形术 全膝置换 股骨 旋转 磁共振成像 

分 类 号：R816.8[医药卫生—放射医学]