我国川南人群胫骨干骺角与胫骨后倾角的测量及临床应用

Study on the correlation between metaphysio-diaphyseal angle and posterior tibial slope angle of southern population in Sichuan China and for tibial osteotomy in total knee arthroplasty

目的研究我国川南人群胫骨干骺角与胫骨后倾角的相关性,为全膝关节置换术中行合理的胫骨截骨提供参考。方法 1在106例无膝关节疼痛、畸形和膝部手术史的成人膝关节侧位X线片上,分为10~29岁组、30~49岁组、50~69岁组、70岁以上组测量胫骨干骺角及胫骨后倾角,并以此数据为依据分析两者是否存在相关性。2对28例30~49岁年龄段的患者行全膝关节置换术,其中16例采用髓内定位进行胫骨截骨(A组),12例采用髓外定位进行胫骨截骨(B组),记录术前、术后2周的膝关节活动度,测量术前、术后的胫骨后倾角。结果 1 30~49岁组的胫骨干骺角与胫骨后倾角存在中度直线正相关关系。2 28例手术患者均获得随访,时间12~18个月,A组术后胫骨后倾角和术后2周膝关节活动度均优于B组,差异有统计学意义(P<0.05)。结论 1确立我国川南人群中30~49岁组的胫骨干骺角与胫骨后倾角呈正相关关系。2在30~49岁人群中行全膝关节置换术时采用髓内定位法行胫骨截骨,可恢复患者胫骨平台的生理后倾角度,获得满意的关节活动度。

Objective To study the correlation between metaphysio-diaphyseal angle and posterior tibial slope angle of Sichuan southern population in order to provide reasonable reference for tibial osteotomy in total knee arthroplasty.Methods 1 The metaphysio-diaphyseal angle and posterior tibial slope angle of knee joint in 106 lateral radiographs were measured,which were divided into 10 - 29,30 - 49,50 - 69,〉 70 years old groups,then analyzed whether the correlation existed between them according to the statistics. 2 The cases adopted total knee arthroplasty in the age group of 30 - 49. Group A（ 16 cases） underwent intramedullary positioning for tibial osteotomy,whereas in group B（ 12 patients） adopted extramedullary tibial osteotomy,and knee ROM before surgery and 2 weeks postoperation were recorded and measured posterior tibial slope angle before and after operation. Results 1 Moderate positive linear correlation existed between metaphysio-diaphyseal angle and posterior tibial slope angle in 30 - 49 years old group. 2All 28 patients were followed up from 12 months to 18 months. But they existed statistical significance between postoperation posterior tibial slope angle and postoperation ROM after two weeks（ P〈0. 05）,and group A was better that group B. Conclusions This study regards China＇s southern population as the research objects,establishes a positive relationship between metaphysio-diaphyseal angle and posterior tibial slope angle,at last it suggests that people in group of 30 - 49 years old adopt intramedullary positioning method for tibial osteotomy in total knee arthroplasty. In this way,patients will gain a good recovery with physiological posterior angle in tibial plateau and obtain satisfactory motion of joint.