|
| 老年性骨关节炎行人工膝关节置换术后 假体旋转对线的定量分析 |
| Quantitative analysis of rotational alignment after total knee arthroplasty in osteoarthritis SUN |
| |
| DOI： |
| 中文关键词: 骨质疏松 人工膝关节置换术 旋转对线 |
| 英文关键词:Total knee arthroplasty Rotational alignment |
| 基金项目: |
|
| 摘要点击次数: 1488 |
| 全文下载次数: 1466 |
| 中文摘要: |
| 目的根据不同解剖标志利用CT扫描定量测量人工膝关节置&术后股骨和胫骨假体的旋转 对线。方法2004年对21位合并膝内翻畸形（35个膝）老年性骨关节炎患者（平均年龄73.3岁，范 围:60?81岁）行人工膝关节置换手术，术中采用后稳定型固定平台膝关节假体，以股骨后髁轴外旋 截骨确定股骨假体旋转定位,综合参考胫骨平台最大覆盖率和胫骨后髁轴确定胫骨假体旋转定位。 术后7年进行随访，内容包括病史采集、物理检查，KSS评计和功能评分，负重位膝关节正侧位X光 片、髌骨轴位片以及膝关节CT扫描。在CT扫描图像上，根据股骨内外上髁轴（SEA)测量股骨假体 旋转角度，分别根据股骨内外上髁轴和胫骨结节内侧1/3测量胫骨假体旋转角度，并以此测算假体的 联合旋转角度和旋转不匹配程度。结果对35个膝关节随访7年结果显示，未出现感染、假体透亮 带、髌骨脱位或半脱位、髌骨骨折、假体松动等，B?S临床评分平均91分，功能评分平均83分。股骨 假体、胫骨假体旋转角度、联合假体旋转角度均呈正态分布；股骨假体平均旋转角度为（3. 02 ±3. 88)°;胫骨假体相对于胫骨结节内侧1/3明显处于内旋位（平均.17°)，相对于SEA旋转角度平均0°， 参考两个标志测量的胫骨假体旋转角度之间有显著差异（P =0.000);相对于SEA确定的假体联合旋 转角度平均（2. 99±7.90)°，相对于胫骨结节内侧1/3确定的假体联合旋转角度平均（-2.64 ±8. 39)°，参考两个参考标志测定假体联合旋转角度之间有显著差异（P =0.005)，股骨和胫骨假体旋转 不匹配最大程度在10°度左右。结论与胫骨结节内侧1/3做比较，股骨内外上髁轴（SEA)更适合作 为CT定量测量人工膝关节置换术后股骨和胫骨假体旋转对线的标志；胫骨平台最大覆盖率和胫骨 后髁轴可以作为胫骨假体旋转定位的参考轴线，但具有较大的个体差异性。 |
| 英文摘要: |
| Objective Rotational malalignment in total knee arthroplasty ( TKA) may be the main cause of patellofemoral complications and the determining factor of postoperative function and survival rate of prosthesis. We measured rotational alignment of femoral and tibial component relative to different landmarks on CT scan images during follow-up. Methods 21 osteoarthritic patients with 35 varus knees were followed up at 7 years after TKA with posterior stabilized prothesis. The posterior femoral condyles had been used as a reference for femoral component positioning, and the tibial component was positioned to maximize tibial coverage and the posterior condyles of the cut proximal tibial surface. The patients were evaluated with physical examination, KSS score, radiological assessment and CT scan. Rotational alignment of femoral and tibial component was measured on CT images with reference to SEA ( surgical epicondyle axis) and medial 1/ 3 of tibial tubercle. Merchant view was used to measure patella tilt angle and shift. Results Rotational angles of femoral and tibial |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |