汉族人群正常股骨远端髁间前后轴线与旋转轴线的对位关系及其临床意义

The study of the distal femur anterior posterior line and rotational alignment in Chinese Han population and its clinical significance

目的 探讨中国汉族人群正常股骨远端髁间前后轴线与旋转轴线的对位关系及在全膝关节置换术中的临床价值。方法 2012年10月—2013年7月，对北京、河北、新疆及重庆的288名健康汉族志愿者行双下肢全长CT扫描，共获得575个正常膝关节图像数据纳入研究进行分析。其中男148名，女140名；年龄17—65岁；左膝288个，右膝287个。通过垂直于股骨机械轴线的断层图像，进行轴线之间的测量，包括髁间前后轴线与外科上髁轴线夹角（ASA），髁间前后轴线与临床上髁轴线夹角（ACA），髁间前后轴线与后髁连线夹角（APA）；按性别和侧别分组进行统计学分析。结果 ASA平均87．19°±1．92°，男性87．03°±1．95°，女性87．35°±1．87°，左膝87．33°±1．88°，右膝87．05°±1．95°；ACA平均90．93°±2．03°，男性90．68°±2．01°，女性91．19°±2．03°，左膝91．05°±1．93°，右膝90．81°±2．13°；APA平均83．99°±2．16°，男性83．86°±2．20°，女性84．12°±2．12°，左膝84．05°±2．09°，右膝83．92°±2．23°。其中ACA在男女性别中的差异具有统计学意义（t=3．000，P=0．003），女性比男性平均大0．51°，其余参数在性别及侧别中差异均无统计学意义（P值均〉0．05）。结论 通过对较大样本的中国汉族人群正常膝关节影像学的CT测量，得到相对准确的汉族人群股骨远端轴线间的对位关系，可以指导术中股骨远端截骨操作，确定适当的股骨外旋。

Objective To explore the distal femur anterior posterior line and rotational alignment in normal Chinese Han population and discuss its clinical application. Methods From October 2012 to July 2013, 288 volunteers（ 148 males and 140 females）from Beijing, Hebei, Xinjiang and Chongqing, aged from 17to 65（36.3 in average）had undergone CT scan of their lower limbs. The CT scan images of 575 normal knees （288 left and 287 right knees ） were obtained. With computer-assisted image processing and reconstruction, the correlative parameters, including anterior posterior line with surgical transepicongdylar axis angle （ ASA）, anterior posterior line with clinical transepicondylar axis angle （ACA） and anterior posterior line with anterior posterior line angle （APA） were measured. The parameters of two groups between males and females, left and right sides were analyzed. Results ASA： 87. 19°± 1.92° in average, 87.03° ±1. 95° in males, 87.35° ± 1.87° in females, 87.33° ± 1.88° in left knees and 87.05° ± 1.95° in right knees; ACA： 90.93°±2.03° in average, 90.68°±2.01° in males, 91.19°±2.03° in females, 91.05° ±1.93° in left knees and 90. 81° ±2.13° in right knees; APA： 83.99°±2. 16°in average, 83.86°± 2.20° in males, 84.12° ± 2.12° in females, 84.05° ± 2.09° in left knees and 83.92°±2.23° in right knees. There was significant difference between males and females in terms of ACA （ t = 3. 000, P = 0. 003 ） and ACA in females was 0.51 o larger than that in males. There was no significant difference both in gender and sides in terms of other parameters （ all P values 〉 0.05 ）. Conclusions The relatively accurate relationship between distal femur anterior posterior line and rotational alignment was obtained by investigating larger samples in Chinese Han population, and it can guide the osteotomy of distal femur to get the appropriate rotational alignment.