外翻膝全膝关节置换术后膝-踝关节力线评估

Radiographic evaluation of knee-ankle alignment after total knee arthroplasty for valgus knee osteoar-thritis

目的本研究的目的是评估膝关节外翻畸形导致踝关节力线异常,以及膝、踝关节力线参数之间相关性,研究全膝关节置换术后膝-踝关节力线改变和参数之间相关性。方法本研究共包括44例全膝关节置换的外翻型膝关节骨性关节炎,站立位下肢全长前后位片测量膝关节力线参数:髋-膝-踝关节角(HKA)、股骨-胫骨角(TFA)、股骨外翻角(FVA)、股骨角(FA)、胫骨角(TA)、膝关节倾斜角(AK);和踝关节参数:胫骨远端关节面角(DTAA)、距骨倾斜角(TTA)、踝关节倾斜角(TAA)。采用双侧检验配对t检验比较膝关节、踝关节手术前、后参数和术后参数变化统计学差异。采用散点图和双侧检验Pearson相关性检验评估膝关节、踝关节参数手术前、后、及手术后参数变化的相关性。结果结果显示膝关节外翻畸形,踝关节出现代偿性内翻。TKA后随着膝关节力线的纠正,各参数显著改善,同时踝关节力学参数发生相一致的改善。踝关节的力线参数改善与膝关节力线参数改变存在中低度相关性(P<0.01)。结论踝关节力学参数与膝关节力学参数存在相关性,全膝关节置换在改变膝关节力线的同时,可以改善踝关节力线,故需要在TKA中尽可能获得3°以内外翻或内翻的膝关节力线,从而尽可能改善踝关节力线,保护踝关节,降低踝关节OA发生。

Objective The aim of this retrospective research is to evaluate the changes in ankle alignment due to knee malalignment and relation with valgus knee osteoarthritis,further study the knee-ankle alignment after total knee arthroplasty(TKA).Methods This research consisted of 44 patients who had underwent primary TKA due to vaglus knee osteoarthroplasty(OA).The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs,both pre-operatively and post-operatively.The knee alignment was estimated according to the hip-knee-ankle angle(HKA),Tibiofemoral angle(TFA),Femoral valgus angle(FVA),Femoral angle(FA),Tibial angle(TA)and Tilt angle of the knee(TAK).The ankel alignment was estimated according to Distal tibial articlar angle(DTAA),Talar tilt angle(TTA)and Tilt angle of ankle(TAA).The patients were separated into two sex-based group.The correlation between the knee and ankle parameters were estimated by the two-tailed paried t-test and Pearson's correlation tests.Results The results showed that valgus knee deformity accompany with the compensatory varus ankle deformity.After TKA,with correclation of knee alignment,the parameters of knee were significantly improved,and the parameters of ankle were uniformly improved.There was correlation between changes of ankle alignment and that of knee alignment(P<0.01).Conclusions The primary TKA could correct the vaglus deformity of a knee,and improve the tilt of the ankle.Ankle alignment correlated with knee alignment both pre-operatively and post-operativly.Both knee and ankle malalignment can be stimulateously corrected following TKA.