中国西南地区单纯半月板损伤患者下肢力线测量及临床意义

Measurement of lower extremity alignment in the patients with simple meniscus injury in Southwest China and its clinical significance

目的测量中国西南地区未合并软骨病变的早期单纯半月板损伤患者的下肢力线角度,分析这一人群的下肢力线特点,为该地区全膝关节置换(TKA)术中截骨提供参考依据。方法将2015年1月至2018年3月陆军军医大学第一附属医院收治的200例中国西南地区早期单纯半月板损伤患者纳入研究,男女各100例,均未合并软骨病变。在患者下肢全长负重位X线片上测量髋-膝-踝角(HKA)、胫骨平台内翻角及股骨外翻角,比较不同性别下肢力线的差异,同时与北美正常人群的下肢力线进行对比。结果中国西南地区单纯半月板损伤患者男性HKA、胫骨平台内翻角、股骨外翻角分别为(176.2±0.6)°、(5.1±0.9)°、(5.7±0.2)°,均大于女性[(175.6±0.6)°,(3.1±0.7)°、(5.7±0.1)°],且HKA及股骨外翻角小于北美正常人群,但胫骨平台内翻角较大(P <0.05)。结论中国西南地区早期单纯半月板损伤患者较北美正常人群的下肢力线内翻趋势明显,且女性下肢力线内翻趋势大于男性;该地区人群TKA术中截骨以股骨远端外翻6.0°,女性后髁外旋3.0°、男性后髁外旋5.0°为宜,但具体截骨角度应根据术前个体化测量结果及术中实际情况决定。

Objectives To measure the angles of lower extremity alignment in the patients in Southwest China with early-stage simple meniscus injury （without cartilage lesions）, to analyze the characteristics of lower limb alignment in this population, and to provide a reference for osteotomy during total knee arthroplasty （TKA） in the same region. Methods A total of 100 adults in each gender who diagnosed as early-stage simple meniscus injury without cartilage lesions in First Affiliated Hospital of Army Medical University from January 2015 to March 2018 were included in this study. On weight-bearing radiographs involved the entire lower extremity,hip-knee-ankle angle （HKA）, tibial plateau-tibial shaft angle （TP-TSA）, and knee physical valgus angle （KPV） were measured in order to look for gender differences, at the same time, comparisons with normal population in North America were also made. Results Among patients with simple meniscus injury in Southwest China, HKA, TP-TSA and KPV of the men were （176.2 ± 0.6）° , （5.1 ± 0.9）° and （5.7 ± 0.2）° respectively, higher than the angles of the women, （175.6 ± 0.6）°, （3.1 ± 0.7）° and （5.7 ± 0.1）° accordingly; furthermore, the HKA and KPV were smaller, and TP-TSA was larger than those of normal population in North America （P 〈0.05）. Conclusions Compared with normal population in North America, patients with early-stage simple meniscus injury in Southwest China have significantly more varus alignment of the lower extremity; the more varus tendency is also manifested in the women when compared with the men. For TKA osteotomy in patients from Southwest China,eversion 6.0° in distal femoral bone cutting, extorsion 3.0° for women and 5.0° for men in posterior condylar bone cutting, is beneficial; However, the specific osteotomy angles should be determined according to the pre-operative measurements and the actual conditions during the operation.