个性化股骨远端外旋截骨在膝关节置换治疗骨性关节炎中的应用  

Application of personalized distal femoral external rotation osteotomy in total knee arthroplasty for knee osteoarthritis

作　　者：樊宗庆 储成顶[1] 符东林[2] 潘檀[2] 马培旗 郁长修 聂宇 胡勇[1] FAN Zongqing;CHU Chengding;FU Donglin;PAN Tan;MA Peiqi;YU Changxiu;NIE Yu;HU Yong(Department of Orthopedics,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui Province,China;Department of Orthopedics,Fuyang People's Hospital Affiliated to Anhui Medical University,Fuyang 236000,Anhui Province,China;The First Clinical College of Anhui Medical University,Hefei 230000,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽合肥230000 [2]安徽医科大学附属阜阳市人民医院骨科,安徽阜阳236000 [3]安徽医科大学第一临床学院,安徽合肥230000

出　　处：《解放军医学院学报》2022年第2期151-156,174,共7页Academic Journal of Chinese PLA Medical School

基　　金：安徽省阜阳市科技局课题(FK202081027)。

摘　　要：背景在人工全膝关节置换术(total knee arthroplasty,TKA)中股骨假体的旋转力线至关重要,术中确定股骨远端外旋截骨的方法较多,各有利弊,目前无统一标准。目的 评价个性化股骨远端外旋截骨在膝关节置换治疗膝关节骨性关节炎中的应用价值。方法 1)采用尸体解剖实验验证CT测量股骨后髁角的可靠性。取10具成人尸体膝关节标本,行膝关节三维CT重建,测量股骨后髁连线(posterior condylar line,PCL)与股骨外科上髁轴(surgical transepicondylar axis,s TEA)之间的夹角,定义为后髁角(posterior condylar angle,PCA)。膝关节标本解剖,模拟TKA,肉眼定位确定s TEA和PCL的4个标记点,用大头针圆头标记,再行膝关节三维CT重建,根据标记点确定PCL和s TEA,测量二者夹角,即PCA’,计算两组角度差异有无统计学意义。2)个性化股骨远端外旋截骨行TKA的临床研究。选取2019年12月-2020年8月阜阳市人民医院骨科收治的101例膝关节骨性关节炎患者,根据股骨远端旋转截骨方法不同随机分为观察组和对照组。观察组参照术前测量PCA行个性化股骨远端外旋截骨完成TKA,对照组采用常规股骨远端外旋3°截骨行TKA。术前测量膝内翻角、胫骨近端内侧角(medial proximal tibial angle,MPTA)、疼痛评分、膝关节活动度(range of motion,ROM)和膝关节协会评分(Knee Society Score,KSS)。术中记录膝关节屈曲90°位软组织平衡情况、髌骨轨迹是否良好。术后测量股骨假体旋转误差和膝内翻角;记录术后3个月和术后1年随访时膝内翻角、疼痛评分、ROM和KSS评分,评价临床疗效。结果 解剖学研究中PCA为4.2°±1.3°,PCA’为4.3°±0.9°,差异无统计学意义(P>0.05)。临床研究中,观察组51例[男性8例,女性43例,年龄50~84(66.9±7.1)岁],对照组50例[男性8例,女性42例,年龄56~83 (67.8±6.4)岁],均成功获得随访。两组测量PCA为4.13°±1.19°,大于常规应用的外旋3°(P<0.05)。两组手术时�Background The rotation alignment of the femoral prosthesis is very important in total knee arthroplasty(TKA). There are many methods to determine the external rotation osteotomy of the distal femur, each has its own advantages and disadvantages,without any unified standards. Objective To evaluate the application value of personalized distal femoral external rotation osteotomy in TKA in the treatment of knee osteoarthritis. Methods Ten adult knee joint specimens were taken for three-dimensional CT reconstruction. The angle between the posterior condylar line(PCL) and the surgical transepicondylar axis(s TEA) was measured, that was defined as the posterior condylar angle(PCA). The cadaver specimens of the knee joint were dissected, and then TKA was simulated, the four points determining the s TEA and PCL were identified by the naked eyes and were marked by round head of pins. Then three-dimensional CT reconstruction of knee joint was performed. According to the marked points, PCL and s TEA were determined, and the angle between them was measured, which was defined as PCA’. The difference of angle between the two groups was compared. From December 2019 to August 2020, 101 patients with knee osteoarthritis were randomly divided into observation group and control group according to different methods of distal femoral rotation osteotomy. Depending on the PCA which was measured preoperatively, individualized external rotation osteotomy of the distal femur was performed in the observation group to complete TKA, while conventional 3° external rotation osteotomy of distal femur was applied in the control group. The knee varus angle, medial proximal tibial angle(MPTA), pain score, range of motion(ROM) and KSS score were measured before operation. During the operation, the soft tissue balance of 90° knee flexion and whether the patellofemoral track was good or not were recorded. The rotation error of femoral prosthesis and knee varus angle were measured after operation, and the knee varus angle, pain score, ROM and KSS

关 键 词：股骨假体旋转 全膝关节置换术 膝 关节成形术 三维CT 

分 类 号：R687.4[医药卫生—骨科学]