摘要
目的测定健康人膝关节胫骨前后轴(anterioposterior axis,AP轴)的解剖学标志,比较膝关节骨关节炎患者合并内翻或外翻畸形的情况下,胫骨前后轴的位移趋势,并判断如果以胫骨结节内1/3作为旋转定位参考点情况下,胫骨假体相对于胫骨前后轴的旋转匹配程度。方法选择32位膝关节骨关节炎患者,共62个膝关节进行膝关节旋转中立位CT扫描,并以10个正常膝关节作为对照,分别测量在胫骨平台层面及髌腱附着点层面,胫骨AP轴与髌腱交点内侧宽度平均比例;胫骨AP轴与PCL中点-髌腱内缘连线角度及其与PCL中点与髌腱内1/3连线之间的角度。结果在髌腱附着点层面,正常膝关节胫骨AP轴和PCL胫骨附着点中点与髌腱内侧缘连线成角约0.57°±5.63°,胫骨AP轴与髌腱交点内侧比例为0.54%±18.63%;在膝关节骨关节炎合并内翻或外翻畸形情况下,胫骨AP轴与髌腱交点内侧所占比例明显增加(P<0.05),合并内翻或外翻畸形的骨关节炎膝关节,胫骨AP轴和PCL中点与髌腱内缘连线夹角增加,PCL中点与髌腱内1/3连线和胫骨AP轴的角度在外旋8°左右。结论健康人胫骨AP轴总体为PCL中点与髌腱内侧缘连线,骨关节炎合并内翻或外翻畸形情况下,胫骨AP轴相对于PCL中点与髌腱内侧缘连线呈外旋趋势,如果以胫骨结节内1/3作为胫骨假体旋转定位参考点,胫骨假体相对于胫骨前后轴具有外旋倾向。
Objective Identify an extraarticular anatomic landmark indicating the anterioposterior orientation of the tibia in healthy Chinese, compare the position change in osteoarthritic knees with varus or valgus deformity, determine the rotation mismatch between tibial anteriorposterior (AP) axis and tibial component in accordance with the medial 1/3 of tibial tuburosity. Methods Analyzing on the axial images of computed tomography of 62 knees with varus and valgus deformity in 32 patients with osteoarthritis who had total knee arthroplasty. At the level of the tibial plateau and the patellar tendon attachment, measure the mean medial percentage width of the intersecting point of the patella tendon and the AP axis, and the mean angles between the AP axis and lines connecting the middle of the posterior crutiate ligament (PCL) to the medial border and medial 1/3 of the patellar tendon attachment. Results At the level of the patellar tendon attachment, the mean medial percentage width of the intersecting point of the patella tendon and the AP axis in health Chinese was 0.54% ± 18.63%, which were increased obviously in osteoarthritic knees with varus and valgus deformities. The mean angle between the AP axis and a line connecting the middle of the PCL to the medial border of patella tendon in health) Chinese was 0.57° ± 5.63°, the angle also was increased in osteoarthritic knees with varus and valgus deformities, which was not significant, but had the tendency of external rotation. The mean angles between the AP axis and a line connecting the middle of the PCL to the medial 1/3 of patella tendon were about 8° in healthy knees and osteoarthritic knees with varus and valgus deformities. Conclusions The medial border of the patella tendon attachment can serve as a reliable anterior anatomic landmark to determine the AP axis of tibia in Chinese healthy knees, but AP axis of tibia were positioned externally to the line of middle of PCL and the medial border of the patella tendon in osteoarthritic knees with varus or valgus deformity. There was a tendency of external rotation for tibial component in accordance with medial 1/3 of tibial tuburosity relative to the tibial AP axis.
出处
《中国骨质疏松杂志》
CAS
CSCD
2007年第3期189-192,174,共5页
Chinese Journal of Osteoporosis
关键词
骨关节炎
胫骨前后轴
人工全膝关节置换
Osteoarthritis
Anterioposterior axes of tibia
Total knee Archroplasty