| 国人股骨远端旋转轴线的影像学研究及其临床意义 |
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投稿时间：2014-12-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 宋兵华 |
SONG Bing-hua |
兰溪市人民医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, Lanxi People′s Hospital, Lanxi 321100, Zhejiang, China |
song.bh@163.com |
| 孙俊英 |
SUN Jun-ying |
苏州大学附属第一医院关节外科, 浙江 苏州 215006 |
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| 倪增良 |
NI Zeng-liang |
兰溪市人民医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, Lanxi People′s Hospital, Lanxi 321100, Zhejiang, China |
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| 何斌 |
HE Bin |
兰溪市人民医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, Lanxi People′s Hospital, Lanxi 321100, Zhejiang, China |
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| 何建群 |
HE Jian-qun |
兰溪市人民医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, Lanxi People′s Hospital, Lanxi 321100, Zhejiang, China |
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| 邵嵘 |
SHAO Rong |
兰溪市人民医院骨科, 浙江 兰溪 321100 |
Department of Orthopaedics, Lanxi People′s Hospital, Lanxi 321100, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第1期，第41-47页 |
| DOI：10.3969/j.issn.1003-0034.2016.01.010 |
| 基金项目: |
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中文摘要:
目的:探讨全膝关节置换术中股骨远端旋转轴线的临床应用价值。
方法:成年国人86例(106膝),男47例(53膝),女39例(53膝);左54膝,右52膝。应用CT垂直于股骨机械轴对股骨远端进行薄层扫描,将获取的通过股骨远端内外上髁的横断面CT图像输入电脑,标识、测量前后轴线(APL)与外科髁上轴(STEA)的外侧夹角(ATA),APL与后髁轴线(PCL)的外侧夹角(APA),APL的垂线(APLP)与PCL的夹角(A-PA),后髁角(PCA),髁扭转角(CTA),CTEA与STEA之间的夹角(CSA).按性别和侧别分组,分析各角度两组间差异,比较CTA、A-PA、PCA、PT角(胫骨平台内翻角)、常数3°之间以及ATA、APA与常数90°间差异,分别对A-PA、PCA与CTA行线性回归分析,用直线回归评定STEA、CTEA、PCL、APL及APLP之间的相关程度。
结果:ATA平均(89.79±1.22)°,APA为(84.84±1.83)°,A-PA为(5.16±1.83)°,PCA为(4.80±1.23)°,CTA为(8.23±1.40)°,CSA为(3.45±0.68)°,以上各角度除CSA性别间差异有统计学意义外,余角度在性别和侧别间差异均无统计学意义。PT角、PCA及A-PA间差异无统计学意义,但分别与CTA、常数3°比较,差异均有统计学意义。常数90°与ATA比较差异无统计学意义,与APA比较差异有统计学意义。PCA与CTA、PCA与A-PA、A-PA与CTA均存在明显相关性。STEA与CTEA、STEA与APL、PCL与STEA均明显相关。APLP和APL均与PCL相关,PCL与CTEA无明显相关性。
结论:国人TKA中,股骨后髁的外旋截骨角度应为5°,方能获得更满意的股骨假体旋转对线。STEA与CTEA是两条性质完全不同的轴线,不能以平行于CTEA作为旋转力线的参考标志,国人股骨远端旋转轴之间的可靠性,分别为STEA> APL> PCL,STEA是股骨远端旋转轴线中最可靠的定位标志。 |
| 【关键词】股骨 关节成形术,置换,膝 体层摄影技术,X线计算机 |
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| Imageology and significances of rotational axes of distal femur on Chinese adults with total knee arthroplasty |
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ABSTRACT
Objective:To explore clinical significance of rotational axis of distal femur on Chinese adults in total knee arthroplasty (TKA).
Methods:There were 86 Chinese adults (106 normal knees) including 47 males (53 knees) and 39 females (53 knees),54 knees were on left and 52 on right. The CT scan was employed in the distal femur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the femoral. The CT images of cross sections across lateral and medial femoral epicondyle were moved to personal computer,lateral angle between anterior posterior line (APL) and surgical transepicondylar axis (STEA)(ATA),lateral angle between posterior condylar line (PCL) and APL (APA),angle between perpendicularity of APL and PCL (A-PA),posterior condylar angle (PCA),condylar twist angle (CTA),angle between clinical transepicondylar axis (CTEA) and STEA (CSA) were measured. These values were divided into different groups according to gender and side,the values of CTA,PCA,A-PA,angle PT (varus of tibia plateau),constant 3°,ATA,APA and constant 90° were compared by statistically. A-PA and PCA,and CTA were analysed statistically with the liner regression,the relationship among CTEA,STEA,PCL,APL and PLP were performed to assess by liner regression.
Results:ATA was (89.79±1.22)°,APA was (84.84±1.83)°,A-PA was (5.16±1.83)°,PCA was (4.80±1.23)°,CTA was (8.23±1.40)°,CSA was (3.45±0.68)°。 All the parameters had no differences on sex and side,but CSA had difference on male and female. There was no difference among angle PT,PCA,A-PA. There was significant difference in CAT,constant 3° and angle PT,PCA,A-PA. There was no difference between ATA and constant 90°,but there was difference between APA and constant 90°。 There was relativity between PCA and CTA,and also PCA and A-PA,CTA and A-PA. There was significant relativity between STEA and CTEA,between STEA and APL,between STEA and PCL,and also between APLP,APL and PCL,but there was no significant relativity between PCL and CTEA.
Conclusion:TKA for Chinese,the section of femoral posteriorcondyle should be external 5° to obtain the optimum rotational orientation. The property is different entirely between STEA and CTEA,the rotational alignment is not performed according to parallel to the CTEA in distal femur. Among STEA,APL,PCL,the STEA is the most reliable mark of rotational alignment of the distal femur,and the PCL is the less reliable mark. |
| KEY WORDS Femur Arthroplasty,replacement,knee Tomography,X-ray computed |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 宋兵华,孙俊英,倪增良,何斌,何建群,邵嵘.国人股骨远端旋转轴线的影像学研究及其临床意义[J].中国骨伤,2016,29(1):41~47 |
| 英文格式: | SONG Bing-hua,SUN Jun-ying,NI Zeng-liang,HE Bin,HE Jian-qun,SHAO Rong.Imageology and significances of rotational axes of distal femur on Chinese adults with total knee arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(1):41~47 |
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