全膝关节置换术中3种股骨旋转截骨参考轴线的准确度对比  

Accuracy of 3 reference axes for femoral rotation in total knee arthroplasty: a comparative study of 124 cases

作　　者：雷凯 刘力铭 范华全 陈欣 杨柳 郭林 LEI Kai;LU Liming;FAN Huaquan;CHEN Xin;YANG Liu;GUO Lin(Center of Joint Surgery,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院关节外科中心,重庆400038

出　　处：《第三军医大学学报》2021年第3期261-266,共6页Journal of Third Military Medical University

摘　　要：目的比较全膝关节置换术(total knee arthroplasty,TKA)中,Whiteside线、外科通髁轴及滑车沟线这3种参考轴线行股骨旋转截骨的准确度。方法回顾性分析本中心2016年8月至2018年6月符合纳入标准的膝关节骨关节炎或类风湿性关节炎患者124例(男性25例,女性99例,中位年龄66.0岁),共133例膝(左膝70例,右膝63例)。基于膝关节CT扫描数据建立其三维模型,分别参照Whiteside线、外科通髁轴及滑车沟线模拟股骨旋转截骨,比较模拟股骨旋转截骨角与其术中实际股骨旋转截骨角的差异,并计算其偏差值及离群度。结果参照Whiteside线、外科通髁轴及滑车沟线所得模拟股骨旋转截骨角与其术中实际股骨旋转截骨角的偏差值分别为(-2.61±2.76)°、(0.79±2.09)°、(-0.65±1.64)°,且三者之间差异具有统计学意义(P<0.001);其偏差>3°的离群度分别为48.12%、11.28%、8.27%。结论与Whiteside线及外科通髁轴相比,全膝关节置换术中参考滑车沟线行股骨旋转截骨的准确度更高。Objective To compare the accuracy of rotation of the femoral component using 3 reference axes in total knee arthroplasty(TKA),namely,the Whiteside line,surgical transepicondylar axis(sTEA),and sulcus line of the trochlear groove.Methods A retrospective analysis was performed on 124 patients(25 males and 99 females,at a median age of 66.0 years;including 133 knees,70 left and 63 right knees)with knee osteoarthritis or rheumatoid arthritis who met the inclusion criteria in our center from August 2016 to June 2018.Based on the three-dimensional model established by knees CT scan data,the rotational alignment of femoral component was simulated with reference to the Whiteside line,sTEA and sulcus line,respectively.The difference was compared between the simulated rotation angle of femoral component and the actual angle of femoral rotation.The deviation and its outlier were calculated.Results The deviation between the actual angle of femoral rotation and the simulated rotation angle of femoral component obtained by referring to the Whiteside line,sTEA and sulcus line was(-2.61±2.76)°,(0.79±2.09)°,and(-0.65±1.64)°,respectively,and the differences between each pair were statistically significant(P<0.001).The percentage of outliers with deviation>3°was 48.12%,11.28%and 8.27%,respectively.Conclusion Compared with the Whiteside line and sTEA,the femoral rotation with the sulcus line as the reference axis is more accurate during TKA.

关 键 词：全膝关节置换 股骨截骨 旋转对线 滑车沟线 Whiteside线 通髁轴 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学] R684.3[医药卫生—基础医学]