严重膝关节类风湿关节炎患者下肢力线的测量分析  

Measurement and analysis of the lower limb alignment in patients with severe knee joint rheumatoid arthritis

作　　者：窦勇[1] 李平[2] 郭邵逸 张亮[1] 边涛 李宏超 周一新[1] DOU Yong;LI Ping;GUO Shaoyi;ZHANG Liang;BIAN Tao;LI Hongchao;ZHOU Yixin(Department of Orthopaedic Surgery,Beijing Jishuitan Hospital,Beijing 100035;Department of Rheumatology and Immunology,Beijing Jishuitan Hospital,Beijing 100035;Shan County Dongda Hospital,Heze 274399,Shandong,China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]北京积水潭医院风湿免疫科,北京100035 [3]单县东大医院骨科,山东菏泽274399

出　　处：《中华骨与关节外科杂志》2022年第2期99-104,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:测量终末期膝关节受累类风湿关节炎(RA)患者下肢力线及膝关节解剖参数并分析畸形来源,为获取全膝关节置换术(TKA)术后理想的下肢力线提供参考。方法:纳入2013年1月至2020年5月因膝RA行TKA患者210例,术前均拍摄负重位双下肢全长X线片,根据下肢力线分为内翻组、中立组、外翻组。测量髋膝踝角(HKA)、机械轴股骨远端外侧角(mLDFA)、机械轴胫骨近端内侧角(mMPTA)及关节线相交角(JLCA),比较各组间上述参数的差异,并进一步分析畸形来源。结果:严重RA外翻力线占比40.5%(85/210),其次为中立力线占比32.9%(69/210),内翻力线占比26.6%(56/210)。内翻组、中立组、外翻组HKA,mLDFA,mMPTA,JLCA组间比较,差异均有统计学意义。内翻组mMPTA、JLCA及外翻组mLDFA、mMPTA均偏离正常参考范围。结论:严重RA下肢力线分布以外翻膝为主,不同力线分布的膝关节下肢解剖不同。内翻组畸形主要来自于胫骨侧及关节间隙;外翻组畸形主要来自于股骨侧及胫骨侧,充分了解RA患者上述解剖特点有助于精确截骨并获取良好的术后力线。Objective: To measure the preoperative lower limb alignment and anatomic parameters of the end-stage involved knee joints in patients with severe rheumatoid arthritis(RA) and analyze the origin of the deformity, so as to provide reference for obtaining ideal postoperative alignment. Methods: A total of 210 consecutive patients undergoing TKA from January 2013 to May 2020 due to RA were included in this study. The patients were divided into varus group, neutral group and valgus group according to the preoperative lower limb alignment. Hip knee angle(HKA), mechanical lateral distal femoral angle(mLDFA), mechanical medial proximal tibial angle(mMPTA) and joint line convergence angle(JLCA) were measured. The differences of the above parameters among the groups were compared, and the source of deformity was further analyzed. Results: In patients with severe RA, valgus alignment accounted for40.5%(85/210);followed by neutral alignment for 32.9%(69/210);varus alignment accounted for 26.6%(56/210). There were significant differences in HKA, m LDFA, m MPTA and JLCA among the three groups. The mMPTA and JLCA in varus group and the mLDFA, mMPTA in valgus group deviated from the normal reference range. Conclusions: In patients with severe RA, the distribution of lower limb alignment is mainly valgus, and the anatomy of lower limb is different with different lower limb alignment distribution. In varus group, the deformities mainly come from the tibial side and joint space;In valgus group, the deformities mainly come from the femoral side and tibial side. A full understanding of the above anatomical characteristics of RA patients is helpful for performing accurate bone cuts so as to obtain good postoperative alignment.

关 键 词：类风湿关节炎 下肢力线 全膝关节置换 膝关节 

分 类 号：R684.3[医药卫生—骨科学]