单髁关节置换中股骨髓内定位杆插入点的解剖学研究  

Anatomical research of entry point for intramedullary guiding rod in uni-compartment knee arthroplasty

作　　者：蔡俊丰[1] 马敏[1] 罗树林[1] 曾文[1] 袁锋[1] 潘张翼 王瀚[1] 尹峰[1] 

机构地区：[1]上海市同济大学附属东方医院关节外科,200120

出　　处：《中华关节外科杂志（电子版）》2017年第5期60-64,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：上海市科学技术委员会科研计划项目14411967300

摘　　要：目的应用数字技术模拟单髁术中定位过程找出国人股骨侧髓内定位杆的插入点,并进行尸体标本实验证实可行性和准确性,为临床应用提供实验性依据。方法成人股骨标本60根,来源于复旦大学医学院,随机分成两组进行单髁置换术,数字组30根,对照组30根。数字组模拟单髁术中定位过程通过三维反求技术,找出股骨侧髓内定位杆的插入点,进行股骨侧定位截骨。对照组采用牛津微创置换(MP)操作手册推荐的方法找到插入点,即股骨钻孔位置必须在股骨前缘前方1 cm处,且紧贴股骨髁间窝内壁内侧,进行股骨侧定位截骨。测量比较两组患者术后股骨假体内外翻角(FCVA),胫骨假体后倾角(FCPSA)。测量统计数字组的插入点与股骨髁最高点水平线的距离来确定国人单髁置换中股骨侧髓内钉定位杆的插入点的理想位置。使用软件SPSS 19.0对两组数据进行分析比较。定量资料采用t检验,P<0.05为差异有统计学意义。结果数字组和对照组术后的FCVA分别为(1.9±1.1)°和(2.5±1.4)°(t=-2.115,P<0.05),FCPSA分别为(8.4±0.7)°和(6.8±2.0)°(t=4.414,P<0.01),两组之间差异均有统计学意义(P均<0.05),而数字组的FCVA及FCPSA更接近0°和10°,并且离散度小,更加精准。插入点的理想位置应在髁间窝最高点与髁间窝内侧缘中间距髁间窝水平线前方1.46 cm左右的位置。结论应用数字化技术找出股骨髓内定位杆插入点进行膝关节单髁置换可以获得更为精确稳定的股骨假体力线。Objective To confirm the feasibility and accuracy of the entry point of the femoral intramedullary guiding rod found based on three—dimensional reverse engineering and computer-aided technology,and provide an experimental basis for clinical application. Methods Sixty cadaver specimen from the Medical School of Fudan University were randomly divided into the trial group（ the digit group） and the control group,30 femurs each. In the trial group,the insertion of femoral guide rod was adjusted according to the preoperative plan using the digital technique. In the control group,conventional Oxford Microplasty（ MP） process was used. The postoperative femoral component valgus/varus angle（ FCVA）,femoral component posterior slope angle（ FCPSA） were measured and compared between two groups. The ideal entry point was dertermined by measuring the distance between the entry point and the horizon line through the deepest point of the intercondylar notch. Software SPSS 19 was used to analyse and compare the data of the two groups,t test was used for measurement data. P〈0. 05 was set as the significant difference. Results The postoperative FCVA was（ 1. 9 ± 1. 1） ° in the trial group and（ 2. 5 ± 1. 4） ° in the control group respectively（ t =-2. 115,P〈0. 05）; the FCPSA was（ 8. 4 ± 0. 7） ° and（ 6. 8 ± 2. 0） °respectively（ t = 4. 414,P〈0. 01）; there was significant difference between the two groups. The postoperative FCVA and FCPSA in the trial group were closer to 0 ° and 7 ° respectively,indicating the position of femoral prosthesis was more precise. The entry point of the femoral intramedullary guiding rod in UKA for Chinese should be situated in the middle between the peak and the inner margin of fossa intercondyloidea femoris,about 1. 46 cm distant from the horizon line through the deepest point of the intercondylar notch anteriorly. Conclusion Femoral prosthesis alignment based on the position of the entry point of intramedullary guiding rod,which is located by digital

关 键 词：关节成形术 置换 膝 外科手术 计算机辅助设计 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R687.4[医药卫生—基础医学]