基于磁共振技术确定股骨远端旋转参照轴线

Distal femoral rotational axis reference method based on magnetic resonance technique

背景:目前临床上对于假体在水平面上以及股骨与胫骨假体的旋转对线问题研究相对比较薄弱。传统股骨远端旋转轴线主要以外科经股骨上髁轴为主,但是由于患者差异性以及解剖和术中显示等原因,导致患者膝关节置换过程中轴线难以准确定位。目的:探讨磁共振技术在股骨远端旋转参照轴线确定中的应用,为人工全膝关节置换术股骨假体旋转力线提供参考和依据。方法:选取南阳市中心医院骨科2014年9月至2015年10月医院诊治的122例无膝关节疾病患者资料进行分析,采用磁共振技术测量外科经股骨上髁轴、临床经股骨上髁轴、前后轴以及股骨后髁轴;同时采用磁共振技术测量股骨后髁角、髁扭转角、后轴线垂线以及后髁轴线的夹角,每组数据测量3次,求取平均值,分析磁共振技术对股骨远端旋转参照轴线确定方法。结果与结论:1比较各角度接近外科经股骨上髁轴的准确性:3°股骨后髁轴>临床经股骨上髁轴>前后轴垂线;22名测量者测量的股骨后髁角差异无显著性意义(P>0.05);第一测量者测量的髁扭转角、后轴线垂线以及后髁轴线的夹角显著低于第二测量者(P<0.05);3结果提示,磁共振技术对于股骨远端旋转参照效果理想,能够准确测量髁扭转角、股骨后髁角、后轴线垂线以及后髁轴线的夹角等指标,且确定方法比较可靠,能够作为全膝关节置换股骨假体旋转对位参考轴线科学的确定方法。股骨远端截骨轴线除外科经股骨上髁轴外,3°股骨后髁轴准确性最高。

BACKGROUND：Problems regarding the prosthesis in the horizontal plane and the rotation of the femur and tibia prosthesis on line are relatively weak.The distal femoral rotation axis is mainly the transepicondylar axis.Due to patient differences as well as anatomy and intraoperative display,it is difficult to accurately locate the axis in the process of knee arthroplasty.OBJECTIVE：To investigate application of magnetic resonance technique in determining the axis of rotation of the distal femur,to provide reference and basis for femoral rotational alignment during total knee arthroplasty.METHODS：Data of 122 cases without knee joint disease,who were diagnosed and treated in the Department of Orthopedics of Nanyang City Center Hospital from September 2014 to October 2015,were analyzed.Magnetic resonance technique was used to measure femoral epicondyle axes（STEA）,femoral epicondyle axes（CTEA）,the anteroposterior axis（APL） and femoral shaft（PCL）.Simultaneously,magnetic resonance technique was utilized to measure femoral ankle angle（PCA）,ankle twist angle（CTA）,axis vertical line and ankle axis angle（PAPA）.Each data were tested three times,and the average value was calculatd.We analyzed the method of magnetic resonance technique to determine reference axis of distal femoral rotation.RESULTS AND CONCLUSION：（1） Accuracy of the angle close to surgical transepicondylar axis：3° PCL CTEA APL vertical line.（2） No significant difference in PCA was detected in two sets of measurements（P〈 0.05）.CTA and PAPA parameters in the first measurement by magnetic resonance imaging diagnosis were significantly lower than the second measurement（P〈 0.05）.（3） Results indicate that magnetic resonance technology provides ideal reference for distal femoral rotation,can accurately measure the CTA,PCA,PAPA and other indicators.It is a more reliable determination method and can be used in scientific determination of femoral rotational alignment reference axis in total knee arthroplasty.Except STEA,the accuracy of 3° PCL is highest.