| 胫骨前嵴作为全膝关节置换术胫骨假体旋转对位解剖参考的可靠性研究 |
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投稿时间：2020-02-16
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| 作者 | Author | 单位 | Address | E-Mail |
| 路玉峰 |
LU Yu-feng |
西安交通大学附属红会医院关节病医院骨坏死与关节重建病区, 陕西 西安 710054 |
Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 任小宇 |
REN Xiao-yu |
西安交通大学附属红会医院关节病医院骨坏死与关节重建病区, 陕西 西安 710054 |
Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 郝阳泉 |
HAO Yang-quan |
西安交通大学附属红会医院关节病医院骨坏死与关节重建病区, 陕西 西安 710054 |
Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
haoyq2008@163.com |
| 许鹏 |
XU Peng |
西安交通大学附属红会医院关节病医院骨坏死与关节重建病区, 陕西 西安 710054 |
Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China |
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| 刘本寅 |
LIU Ben-yin |
西安交通大学附属红会医院影像科, 陕西 西安 710054 |
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| 期刊信息：《中国骨伤》2021年，第34卷，第5期，第417-424页 |
| DOI：10.12200/j.issn.1003-0034.2021.05.005 |
| 基金项目:陕西省重点研发计划（编号：2019SF-214） |
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中文摘要:
目的： 通过CT测量正常膝关节探讨胫骨前嵴作为全膝关节置换术（total knee arthroplasty，TKA）胫骨旋转对线参考的可靠性。
方法： 自2017年7月至2018年6月选择122例因下肢创伤行CT血管造影（computed tomography angiography，CTA）检查的患者，其中男89例，女33例；年龄18~81（51.4±16.4）岁。使用影像归档和通信系统（picture archiving and communication system，PACS）标记健侧正常膝关节的外科通髁线（surgical epicondylar axis，SEA），外侧平台远端8 mm平面的髌韧带内侧缘与后叉韧带胫骨止点中点的连线（髌韧带内侧缘轴），胫骨横轴，髌韧带止点与后叉韧带胫骨止点中点投影的连线（Akagi线），髌韧带止点中内1/3与后叉韧带胫骨止点中点投影的连线（髌韧带止点中内1/3轴），胫骨结节中内1/3与后叉韧带胫骨止点中点投影的连线（Insall线），胫骨结节内侧缘与后叉韧带胫骨止点中点投影的连线（胫骨结节内侧缘轴）。把前缘锐利的胫骨前嵴等分为3部分，取上下顶点和中间2个点，标记4个点在该平面与与后叉韧带胫骨止点中点投影的连线（胫骨前嵴近端轴、胫骨前嵴中段轴1、胫骨前嵴中段轴2以及胫骨前嵴远端轴）。测量胫骨横轴和SEA之间以及其他各轴与SEA垂线的角度。对比10个胫骨轴之间的两两关系。
结果： 髌韧带内侧缘轴、胫骨前嵴近端轴、胫骨前嵴中段轴1、胫骨前嵴中段轴2、胫骨前嵴远端轴、Akagi线、髌韧带止点中内1/3轴、Insall线、胫骨结节内侧缘轴与SEA垂线的角度分别为（-1.6±4.5）°、（12.0±6.9）°、（7.2±8.6）°、（7.1±10.4）°、（6.6±13.5）°、（1.4±5.0）°、（10.2±5.1）°、（11.9±5.4）°和（3.6±4.8）°。胫骨横轴与SEA的夹角为（4.1±5.3）°。髌韧带内侧缘轴相对于SEA外旋，Insall线、髌韧带止点中内1/3轴和胫骨前嵴近端轴明显大于Akagi线、胫骨横轴、胫骨结节内侧缘轴（P<0.001）。胫骨前嵴中段轴1和2以及胫骨前嵴远端轴明显大于Akagi线、胫骨横轴、胫骨结节内侧缘轴（P<0.001）。但是胫骨前嵴中段轴1和2以及胫骨前嵴远端轴小于Insall线、髌韧带止点中内1/3轴和胫骨前嵴近端轴（P<0.01）。胫骨前嵴中远段3个轴间比较差异无统计学意义（P>0.05）。
结论： 胫骨前嵴中段可以作为TKA胫骨假体旋转对线参考一个选择，其可靠性优于Insall线，但要差于Akagi线、胫骨横轴和胫骨结节内侧缘轴。 |
| 【关键词】关节成形术,置换,膝 解剖标记 假体调节 |
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| Reliability of tibial anterior crest as the anatomical reference of rotating alignment for tibial component in total knee arthroplasty |
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ABSTRACT
Objective: This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA.
Methods: The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system(PACS) was used to mark 11 lines including the surgical epicondylar axis(SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon(MEPT)connecting the middle of the posterior cruciate ligament(PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle(MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest(MATC2) and the axis of the distal anterior tibial crest(DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired t-test.
Results: The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6±4.5)°, (1.4±5.0)°, (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was(4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT(P<0.001). MATC1, MATC2 and DATC were also significantly greater than Akagi line, MBTT axis and TAT(P<0.001). However, MATC1, MATC2 and DATC were also significantly less than M1/3 axis, Insall line and PATC(P<0.01). There were no significant statistical differences between MATC1, MATC2 and DATC(P>0.05).
Conclusion: The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT. |
| KEY WORDS Arthroplasty,replacement,knee Anatomic landmarks Prosthesis adjustment |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 路玉峰,任小宇,郝阳泉,许鹏,刘本寅.胫骨前嵴作为全膝关节置换术胫骨假体旋转对位解剖参考的可靠性研究[J].中国骨伤,2021,34(5):417~424 |
| 英文格式: | LU Yu-feng,REN Xiao-yu,HAO Yang-quan,XU Peng,LIU Ben-yin.Reliability of tibial anterior crest as the anatomical reference of rotating alignment for tibial component in total knee arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(5):417~424 |
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