三维CT重建观察膝骨关节炎患者股骨远端旋转解剖标志的变化

Variability of distal femoral rotational landmarks of osteoarthritic knees under three dimensional CT observation

目的采用三维CT测量膝骨关节炎患者远端旋转解剖标志的变化。方法选择因膝骨关节炎而行全膝关节置换术的患者75例(112膝),其中内翻型92膝(内翻组)、外翻型20膝(外翻组);Ⅲ期股骨头坏死34例(68膝)作为正常组。回顾性分析3组术前的CT资料,采用三维CT重建的方法测量股骨与胫骨机械轴夹角(mFTA)、解剖股骨远端外翻角(aLDFA)、解剖胫骨近端内翻角(aMPTA)、股骨后髁角(PCA)、股骨髁扭转角(CTA),Whiteside线与股骨后髁连线(PCL)的夹角(WPCL)、与外科髁上轴(SEA)的夹角(WSEA)及与临床髁上轴(CEA)的夹角(WCEA)。结果内翻组mFTA、WPCL、WSEA、WCEA均高于正常组,aMPTA、PCA、CTA均低于正常组;外翻组aMPTA、PCA、CTA、WPCL、WSEA、WCEA均高于正常组,mFTA、aLDFA均低于正常组;P均<0.05。内翻组PCA与mFTA呈负相关(r=-0.555),与aMPTA呈正相关(r=0.450);外翻组PCA与mFTA呈负相关(r=-0.614),与aLDFA呈负相关(r=-0.719);P均<0.05。随着mFTA逐渐增大至15°,内翻组PCA、CTA逐渐减小,P均<0.05。结论膝骨关节炎患者均存在Whiteside线外移;内翻型患者PCA、CTA均降低,PCA与mFTA和aMPTA相关;外翻型患者PCA、CTA均升高,PCA与mFTA和aLDFA相关。

Objective To observe the variability of distal femoral rotational landmarks of osteoarthritic knees .Meth-ods Seventy-five patients （ 112 knees ） who underwent total knee arthroplasty for osteoarthritis were chosen , including 92 varus knees （ varus group ） , 20 valgus knees （ valgus group ）; and 34 patients （ 68 knees ） with stage Ⅲ necrosis of the femoral head were selected as the normal group .A retrospective analysis of three-dimensional CT reconstruction of preoper-ative data of the three groups were conducted , and the mechanical femoral tibial angle （ mFTA） , the anatomical lateral dis-tal femoral angle （aLDFA）, the anatomical medial proximal tibia angle （aMPTA）, the femoral posterior condylar angle （PCA）, condylar twist angle （ CTA）, and the angles between Whiteside line and the PCL （ posterior condylar line, WPCL）, SEA （surgical epicondylar angle, WSEA）, CEA （clinical epicondylar angle, CEA） were measured.Results The mFTA, WPCL, WSEA, and WCEA in the varus group were larger than those of the normal group , while the aMPTA, PCA, and CTA were smaller .The aMPTA, PCA, CTA, WPCL, WSEA, and WCEA in the valgus group were larger than those of the normal group, while the mFTA and aLDFA were smaller than those of the normal group （all P〈0.05）.The PCA in the varus group was negatively correlated with mFTA （ r=-0.555 ） , and positively correlated with the aMPTA （r=0.450）; the PCA in the valgus group was negatively correlated with the mFTA （r=-0.614） and aLDFA （r=-0.719）, all P〈0.05.When mFTA gradually increased to 15 ＆#176;in the varus group, the PCA and CTA decreased , all P〈0.05.Conclusions The Whiteside line had a lateral shifting trend in the osteoarthritic knees .The PCA, and CTA were smaller in the varus knees and were correlated with mFTA and aMPTA;the PCA, and CTA were larger in the valgus knees＆amp;nbsp;and were associated with mFTA and aLDFA .