摘要
目的探讨运动学对线全膝关节置换(KA-TKA)术中外侧滑车截骨面覆盖不全与下肢对线参数之间的关系。方法回顾性分析2018年5月—2020年7月在北京朝阳医院行KA-TKA手术治疗的48例(54膝)患者资料,其中男12例、女36例,年龄57~85(69±6.7)岁。23例(23膝)使用个性化截骨工具辅助手术,25例(31膝)使用常规器械测量截骨工具。通过术前下肢负重位全长X线片、膝关节CT、术中测量等方法获取患侧的髋-膝-踝(HKA)角、机械股骨远端外侧角(mLDFA)、关节线汇聚角(JLCA)、胫骨近端内侧角(MPTA)和髁上轴角(TEAA)作为自变量,采用CT、术中测量等方法测量外侧股骨滑车中间和下方两水平的裸露截骨面宽度(分别记为MIDcover和INFcover截骨面宽度)作为因变量,采用Spearman进行相关性分析和简单线性回归分析。结果54膝中有37膝(87%)存在不同程度的外侧滑车截骨面覆盖不全,MIDcover和INFcover截骨面宽度[M(QR)]分别为2.8 mm(2.6 mm)和2.3 mm(2.5 mm),两者与mLDFA均呈负相关关系(rs=-0.839、-0.691,P值均<0.05),与HKA亦均呈负相关(rs=-0.574、-0.585,P值均<0.05),而与TEAA和MPTA无相关性(P值均>0.05)。进一步简单线性回归分析结果显示mLDFA对MIDcover和INFcover的截骨面宽度影响更大,回归系数分别为-0.703(R2=0.708)和-0.473(R2=0.489)。结论当使用传统假体实施KA-TKA时,术中滑车外侧截骨面覆盖不全非常普遍。股骨远端关节线的外翻角度越大,外侧滑车截骨面覆盖不良越明显。
Objective This study aimed to explore the correlation between the insufficient coverage of lateral trochlear bone resection and the various alignment parameters of the lower extremities in kinematically aligned total knee arthroplasty(KA-TKA).Methods Forty-eight patients(54 knees)who underwent KA-TKA surgery at Beijing Chaoyang Hospital from May 2018 to July 2020 were retrospectively investigated.The patients comprised 12 males and 36 females who were aged 69±6.7 years(range:57-85 years).Twenty-three patients(23 knees)underwent surgery using patient-specific instruments,and conventional instruments with caliper and other special tools were used in 25 patients(31 knees).The hip-knee-ankle(HKA)angle,the mechanical distal femoral lateral angle(mLDFA),the joint line convergence angle(JLCA),the medial proximal tibial angle(MPTA),and the transepicondylar axis angle(TEAA)were obtained through full-length weight-bearing X-ray,CT,or intraoperative measurement and used as independent variables.The exposed resection bone surface data at the middle(MIDcover)and inferior(INFcover)levels of the patients'lateral femoral trochlear were recorded through CT or intraoperative caliper measurements and used as dependent variables.Spearman correlation and linear regression analyses were conducted.Results Among the 54 knees,37(87%)had varying degrees of lateral trochlear resection coverage insufficiency,with MIDcover and INFcover being 2.8 mm(2.6 mm)and 2.3 mm(2.5 mm)[M(QR)],respectively.MIDcover and INFcover had a significant negative correlation with mLDFA,and the correlation coefficients were-0.839 and-0.691(all P values<0.05),respectively;they were also significantly negatively correlated with HKA,and the correlation coefficients were-0.574 and-0.585(all P values<0.05),respectively.The insufficient coverages were not significantly correlated to TEAA and MPTA.Linear regression analysis showed that MPTA had a great impact on MIDcover and INFcover,with regression coefficients of-0.703(R2=0.708)and-0.473(R2=0.489),respectively.Conclus
作者
王志为
温亮
宋大勇
马德思
王晓红
曲铁兵
Wang Zhiwei;Wen Liang;Song Dayong;Ma Desi;Wang Xiaohong;Qu Tiebing(Department of Orthopaedic Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;Beijing Naton Medical Technology Innovation Center Co.,Ltd,Beijing 100038,China;Center of Diagnosis and Treatment for Joint Disease,China Rehabilitation Center,Beijing 100068,China)
出处
《中华解剖与临床杂志》
2021年第2期155-161,共7页
Chinese Journal of Anatomy and Clinics
基金
国家自然科学基金(81572180)。
关键词
关节成形术
置换
膝
骨关节炎
运动学对线
股骨滑车
解剖学
Arthroplasty,replacement,knee
Osteoarthritis
Kinematic alignment
Femoral trochlear
Anatomy
