国人全膝关节置换术中股骨远端旋转对线方法的研究

Study on distal femur rotational alignment method in the total knee arthroplasty( TKA) for Chinese people

目的:探讨国人正常股骨远端旋转对线各个标志的临床意义。方法:将80例志愿者160个正常膝关节,按性别分为2组,并按侧别为左、右侧组。然后采用MRI扫描膝关节,依据Dalury方法获取胫骨矢状位、冠状位图像,将图像输入电脑建立股骨远端三维重建图像;在三维重建图像上测量4条轴线及4条轴线所形成的5个夹角。分别比较男、女组及左、右侧组临床上髁轴线与外科上髁轴线夹角、髁扭转角、前后轴线的垂线与外科上髁轴线夹角、股骨后髁角。结果:男性组股骨后髁角、髁扭转角、前后轴线的垂线与外科上髁轴线夹角均大于女性组[3.26°±0.47°;2.76°±1.51°,t=4.125,P=0.000;6.21°±0.73°,5.71°±0.92°,t=4.125,P=0.000;0.32°±0.63°,1.18°±0.59°,t=5.165,P=0.000];男性组与女性组前后轴线的垂线与后髁轴线夹角、临床上髁轴线与外科上髁轴线夹角比较,组间差异无统计学意义[4.65°±0.61°,4.27°±0.27°,t=1.389,P=0.141;2.64°±0.51°,2.98°±0.78°,t=1.821,P=0.078]。左侧组股骨后髁角、髁扭转角、前后轴线的垂线与外科上髁轴线夹角、前后轴线的垂线与后髁轴线夹角、临床上髁轴线与外科上髁轴线夹角与右侧组比较,差异均无统计学意义[3.22°±0.88°,3.43°±1.02°,t=0.081,P=0.930;6.18°±1.25°,6.41°±1.53°,t=0.035,P=1.105;4.37°±0.46°,4.12°±0.61°,t=0.000,P=0.815;0.85°±0.62°,0.81°±0.56°,t=0.497,P=0.926;2.69°±0.71°,2.72°±0.79°,t=0.121,P=0.835]。结论:国人正常股骨远端旋转对线标志存性别差异,但不存在侧别差异;这提示在全膝关节置换术中应根据具体情况选择股骨远端旋转对线的轴线,以确保患者在术后获得良好的治疗效果。

Objective：To explore the clinical significance of normal distal femur rotational alignment anatomic landmark in Chinese people. Methods：Eighty volunteer with 160 normal knee-joints were divided into 2 groups according to their gender and they were also di- vided into left side group and right side group. Then the knee joints were scaned by MRI, and the sagittal and coronary images were obtained by using the Dalury method. The images were inputed into the computer to build 3D reconstructed images of distal femur and the four axes and the five angles formed by the four axes were measured on the 3D reconstructed images. The angle between CTEA and STEA（CSA） ,the condylar twist angle （CTA）, the angle between the perpendicular of APL and STEA （ATA）and the posterior condylar angle （PCA）were compared between male group and female group and between left side group and right side group respectively. Results：The PCA, CTA and ATA of male group were all greater than that of female group（3.26 ＋/-0.47 vs 2.76 ＋/- 1.51 degrees, t = 4. 125,P = 0. 000;6.21 ＋/- 0.73 vs 5.71 ＋/-0.92 degrees,t =4. 125 ,P =0.000;0.32 ＋/-0.63 vs 1.18 ＋/-0.59 degrees,t =5. 165 ,P =0.000）. There was no sta- tistical difference in APA and CSA between male group and female group（4.65 ＋/-0.61 vs 4.27 ＋/-0.27 degrees ,t = 1. 389 ,P =0. 141 ; 2.64 ＋/-0.51 vs 2.98 ＋/-0.78 degrees,t = 1. 821 ,P =0. 078）. There was no statistical difference in PCA,CTA,ATA,APA and CSA between left side group and right side group （3.22 ＋/- 0.88 vs 3.43 ＋/- 1. 02 degrees, t = 0. 081, P = 0. 930 ; 6.18 ＋/- 1.25 vs 6.41 ＋/- 1.53 degrees, t = 0. 035,P = 1. 105 ;4.37 ＋/- 0.46 vs 4.12 ＋/- 0.61 degrees,t = 0. 000, P = 0. 815 ;0.85 ＋/- 0.62 vs 0.81 ＋/- 0.56 degrees,t =0. 497 ,P =0. 926;2.69 ＋/-0.71 vs 2.72 ＋/-0.79 degrees,t =0. 121 ,P = 0. 835 ）. Conclusion：There is gender difference in normal distal femur rotational alignment anatomic landmark in Chinese people while there is no side difference. Therefore, the axes of distal femur rotational alignment should be chosen according to the specific conditions in TKA, so as to ensure good therapeutic effect after the treatment.