双下肢全长负重位与非负重位摄影在全膝关节置换术前评估的研究

Comparative study of full-length both lower extremities weight-bearing and non-weight-bearing X-ray radiography in total knee arthroplasty

目的分析负重位与非负重位下肢力线的差异,探讨双下肢全长摄影在全膝关节置换术中的应用价值。方法回顾性分析我院41例接受全膝关节置换术的患者资料,术前所有患者均行双下肢全长负重位与非负重位X线片,测量负重和非负重位下肢力线(膝内翻角)、股骨力线、关节间隙夹角及胫骨平台内侧夹角。结果负重位膝内翻角、股骨力线、关节间隙夹角均大于非负重位,差异有统计学意义(P<0.01);负重、非负重位膝内翻角及其差值均呈正相关(r=0.569~0.992,P<0.01);负重、非负重位膝内翻角及其差值与关节间隙夹角呈正相关(r=0.567~0.632,P<0.01);负重、非负重位膝内翻角和关节间隙夹角及其各自差值分别与胫骨平台内侧夹角均呈负相关(r=-0.751^-0.491,P<0.01);负重与非负重位股骨力线呈正相关(r=0.989,P<0.01),但与其差值不相关(r=0.199,P>0.01);负重、非负重位股骨力线及其差值与胫骨平台内侧夹角不相关(r=-0.123~0.104,P﹥0.01)。结论全膝关节置换术前评估,负重位比非负重位片更准确,具有重要的临床价值;非负重位对了解韧带松弛程度,平衡周围软组织有意义,建议作为参考。

Objective To analyze the differences in measurement of full-length both lower extremity alignment between weight-bearing and non-weight-bearing X-ray radiography and investigate its value of clinical application in total knee ar- throplasty. Methods We retrospectively reviewed 41 cases （82 knees） of total knee arthroplasty, the weight-bearing and non-weight-bearing X-ray radiography of full-length both lower extremity alignment were carried out preoperatively in total knee arthroplasty, and measured the varus angles of their sick knees, the valgus angles of distal femur, the inra- articular varus or valgus angles and the slope angles of the medial tibial plateaus of the patient between weight-bearing and non- weight-bearing X-ray radiography. Results The differences were statistical significance between the weight-bearing and non-weight-bearing of varus angles, the inra- articular varus or valgus angles. Moreover there was a positive correlation between them and their differences of these two angles （ r =0. 569-0.992, P〈0.01）, and being a positive correlation be- tween varus angles and the inra- articular varus or valgus angles （ r =0. 567-0.632, P〈0.01）. The slope angles of the medial tibial plateaus were inverse correlated with the weight-bearing varus angles,or non-weight-bearing varus angles, or the inra-articular varus or valgus angles （ r =-0. 751- -0.491, P〈0.01） ;But the slope angles of the medial tibial plat- eaus were no correlated with the valgus angles of distal femur,or their differences. Conclusion For patients undergoing total knee arthroplasty, weight-bearing DR radiography is more important than non-weight-bearing to response the varus angles of their sick knees, the valgus angle of distal femur and the intra-articular varus or valgus angles of the patient, which iS more important clinical value in preoperative planning and postoperative outcomes of total knee arthroplasty, and as for intraoperative reference, measurement of the non-weight-bearing alignment was also needed to understand the sever- ity of loosened ligament and balance the surrounding soft tissue.