正常成人股骨远端后髁角的测量及其临床意义

目的测量正常成人股骨远端后髁角,为国人行全膝关节置换术时的旋转对线提供参考数据。方法118例(186膝)膝关节无疾病、无畸形的苏皖地区成年人,男67例103膝,女51例83膝。年龄18～69岁,平均39.7岁。按年龄分成三组,A组18￣39岁(85膝),B组40￣59岁(73膝),C组≥60岁(28膝)。用CT扫描技术对股骨远端垂直于膝关节的机械轴进行薄层扫描,选取通过内、外上髁的CT扫描影像测定后髁角。结果男103膝,左侧57膝,右侧46膝;股骨远端后髁角:左侧5.9°±1.6°,右侧5.6°±2.6°,平均5.8°±2.2°。女83膝,左侧38膝,右侧45膝;股骨远端后髁角:左侧5.5°±2.5°,右侧5.2°±1.5°,平均5.3°±1.9°。各年龄组股骨远端后髁角:A组平均5.5°±1.9°,B组平均5.7°±1.8°,C组平均5.5°±2.7°。统计学分析表明,股骨远端后髁角在不同性别、侧别和年龄间比较,差异无统计学意义。结论苏皖地区成人正常股骨远端后髁角平均为5.6°±2.1°,明显大于西方人,且男女无差异。在对中国人进行全膝关节置换术时,依据股骨远端后髁线,参照欧美外旋3°的标准进行旋转对线可能会导致膝关节对线不良。     

华南地区正常成人股骨远端髁扭转角测量及其临床意义

目的探讨华南地区正常成人的膝关节股骨远端髁扭转角具体数值,并分析其在性别和侧别间有无统计学差异。方法招募华南地区（往上数五代以内均生在华南地区,包括广东、广西或者海南）正常成人志愿者71例（142膝）,男38例（76膝）,女33例（66膝）,年龄20～45岁,平均30．56岁,体重40—80kg,平均59．90kg,身高151—185cm,平均167．80cm。通过螺旋CT扫描志愿者膝关节,所得原始数据（DICOM3）刻录为光盘,导入MIMICS10．01中,选择通过股骨内外上髁的层面进行测量股骨远端髁扭转角。结果所测得华南地区正常成人的股骨远端髁扭转角：男性为（6．20°±2．03°）,女性为（7．19°±1．78°）,均值为（6．66°±1．97°）,性别之间差异有统计学意义（t=3．077,P〈0．01）;左侧为（6．86°±1．92°）,右侧为（6．45°±2．02°）,侧别间无统计学差异（t=1．238,P〉0．05）。总体股骨远端髁扭转角为（2．39°～11．34°）,均值（6．66°±1．97°）。结论对华南人的人工全膝关节置换术中,传统的外旋3。截骨可能会导致对线不佳,应该适当提高旋转对线的外旋度数。     

人工膝关节置换治疗股骨髁上骨折合并膝关节骨性关节炎疗效观察

目的分析应用人工膝关节置换治疗股骨髁上骨折合并膝关节骨性关节炎的治疗效果。方法将100例股骨髁上骨折合并膝关节骨性关节炎患者随机分为对照组和观察组两组,每组50例。对照组采用钢板置入,观察组采用人工膝关节置换,比较两组效果及术后并发症情况。结果两组均获随访3个月,观察组优良率96.67%。对照组76.67%,两组比较,差异有统计学意义(P0.05)。观察组中术后并发症发生率5.00%,对照组术后并发症发生率40%,两组比较,差异有统计学意义(P0.05)。结论人工膝关节置换治疗股骨髁上骨折合并膝关节骨性关节炎具有良好的临床效果,术后并发症发生率较低,患者恢复时间短,有效提升了患者的康复效果。     

全膝关节置换术股骨远端相关解剖的研究进展

全膝关节置换术(total knee arthroplasty,TKA)能够有效的恢复膝关节生理力线、解除膝关节疼痛、恢复膝关节正常的功能,是治疗终末期膝骨性关节炎的有效的方法[1～3]。拟行TKA的患者通常伴有股骨远端解剖标志不清和形态的改变。TKA术中股骨假体的旋转力线是影响术后膝关节功能和假体使用寿命的重要因素,股骨假体旋转不良可导致术后髌骨轨迹异常、膝前区疼痛、胫股假体部件间剪切扭转应力增加和屈膝不稳定等[4-5]。因此如何精确定位股骨远端各     

正常膝关节几何学及其参数的测量

目的 建立正常典型的膝关节三维解剖模型，并对之进行测量。方法 对正常膝关节进行扫描，以数字化的形式输入到计算机中，建立典型膝关节三维解剖模型，并对其线性、角度等15项指标进行测量。结果 ①所建立的膝关节三维解剖模型，代表了绝大多数人的膝关节特征；②膝关节线性尺寸之间、身高与线性尺寸之间均有很好的相关性；③角度指标是相对独立的一组指标。结论 典型的膝关节三维解剖模型，能为膝关节参数的测量提供一种可靠的方法。     

CT扫描确定全膝关节置换股骨假体旋转力线的研究

目的探讨术前CT扫描对全膝关节置换(TKA)中股骨假体旋转力线精确确定的作用。方法将200例(252膝)TKA患者随机分为两组:①经验组(64例):TKA术中根据术者触摸外科股骨上髁轴线联合Whi-teside线联合确定股骨假体外旋角度;②CT扫描组(136例):术前CT扫描确定股骨后髁角,术中采用可调外旋定位器复制CT确定的外旋角度,其余TKA手术操作相同。两组术后均行CT扫描确定股骨假体旋转不良角度并对其绝对值进行比较。结果经验组TKA术后股骨假体旋转不良角度为2.8°±0.14°,CT扫描组为1.2°±0.04°,两组比较差异有统计学意义(t=4.18,P<0.01)。经验组股骨假体旋转不良率为32.1%,CT扫描组为18.5%,两组比较差异有统计学意义(χ2=17.47,P<0.01)。结论术前CT扫描确定股骨远端后髁角可以有效提高TKA手术股骨假体旋转力线,方法简单、有效、重复性良好。     

成人正常膝关节的运动状态分析

目的分析成人正常膝关节运动状态,为改进和设计符合国人解剖特点的膝关节假体提供参考数据。方法随机选取120名(240膝,男女各半)膝关节正常的中国成年人,年龄21～40岁,平均30.6岁,身高1.60～1.75m。受试者作膝关节的过屈膝运动,通过X线透视成像技术,获得双侧膝关节不同体位时的连续侧位X线片。股骨髁上前方的关节球面为伸展面(extensionfacet,EF),后方的关节球面为屈曲面(flexionfacet,FF);两个球面的圆心分别定义为伸展面球心(extensionfacetcenter,EFC)和屈曲面球心(flexionfacetcenter,FFC)。然后测量关节在不同体位时,后部胫骨皮质与同侧股骨髁后方关节面球心的间距,通过胫骨内外侧软骨下骨性标志中最突出的两个点引一条直线,再引第二条直线垂直于前者,并与后部的胫骨皮质正切。屈曲面球心FFC到第二条直线的距离为d1,伸展面球心EFC到第二条直线的距离为d2,分别测量关节在不同体位时d1和d2的长度。不同体位时d1、d2长度变化的绝对值即为膝关节屈曲时股骨和胫骨的相对运动范围。所得数据用SAS软件进行双因素方差分析。结果不同性别、侧别间膝关节股骨内侧髁及外侧髁的运动范围差异均无统计学意义。成人正常膝关节屈曲时股骨和胫骨的相对运动范围:内侧髁(1.4±0.3)mm,外侧髁(15.9±4.7)mm。结论国人正     

股骨髁前后径与内外径比值对膝关节置换的影响

[目的]测量股骨髁的前后径、内外径,分析两者的比值对全膝关节置换的影响。[方法]选取2015年10月～2017年12月行全膝关节置换的170例患者,手术前利用X线片在膝关节上对股骨髁的前后径、内外径进行测量,算出两者比值,对比假体数据,将比值>0.9的60例患者分为两组,对照组:采取髓内长定位杆截骨;研究组:采取髓内短定位杆截骨,均为30例,对两组临床效果进行比较。[结果]两组患者术后均未出现感染、假体周围骨折及假体松动;两组患者术后KSS评分、伸直角度和伸膝障碍所占比例差异均无统计学意义(P>0.05);两组膝关节屈曲角度、股骨假体屈曲角度和股骨前端切迹差异均有统计学意义(P<0.05)。[结论]针对股骨髁前后径、内外径比值较大者,采取髓内短定位杆截骨能够维持伸屈稳定,降低截骨切迹和假体周边骨折发生概率,临床应用效果良好。     

采用半股骨膝关节置换治疗老年股骨髁上骨不连

目的探讨老年人股骨髁上骨折骨不连的治疗。方法采用手术治疗,一期采用半股骨膝关节置换术或先期取出内固定物;术后3～6个月后采用半股骨膝关节置换术恢复膝关节功能。结果治疗5例,术后12个月均有随访。4例3～6个月内弃拐,1例术后8个月弃拐;5例功能恢复良好。结论采用人工半股骨铰链式膝关节假体置换治疗老年股骨髁上骨折骨不连的治疗方法值得参考。     

国人全膝置换术股骨远端截骨面解剖参数测量

[目的]应用三维CT重建测量正常国人膝关节股骨远端截骨面解剖形态学参数,为国产人工膝关节股骨假体的设计提供参考依据。[方法] 2022年3月—2022年10月对187例（男94例,女93例）汉族正常膝关节进行CT三维重建,测量股骨内外径（medial-lateral, ML）、股骨前后径（anterior-posterior, AP）、股骨内侧髁宽度（medial condyle width, MCW）、股骨外侧髁宽度（lateral condyle width, LCW）、股骨髁间窝宽度（width of intercondylar fossa, WICF）、股骨髁间窝高度（height of intercondylar fossa, HICF）,并计算ML/AP比值,比较各参数性别差异及相关性。[结果]股骨远端各解剖数据测量值男性均显著大于女性（P<0.05）。股骨远端截骨面测量值中除MCW与WICF (r=0.087, P=0.236)、LCW与WICF (r=0.052, P=0.478)、HICF与ML/AP (r=0.023, P=0.757)之间无显著的相关关系,其...     

Periprosthetic fractures of the femur after total knee arthroplasty

Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur.     

膝关节置换时股骨髓内定位对假体排列的影响

目的 :探讨膝关节置换时股骨髓内定位杆进针点的位置对下肢力线造成的误差及其相关的影响殷素。方法 :选取行TACK膝关节置换的骨关节病患者 40例。术中股骨截骨髓内定位杆的进针点为股骨滑车中心。术前术后于 14英寸× 17英寸X线片测量膝关节的股胫角 (FTA)、股骨外侧角。并根据数学模型计算TACK置换后可能造成的最大误差。结果 :股骨解剖轴线一般与股骨内侧髁相交 ,距滑车中心平均 7mm ( 0～ 11mm) ,膝外翻者股骨解剖轴线偏离滑车中心更多。术后测量股骨假体外侧角为 80～ 90° ,内外翻误差 2°以内者占 70 % ,理论计算如果进针点位于滑车中心 ,会导致外翻误差增加。结论 :真正的髓内定位杆进针点应位于股骨解剖轴线上 ,进针点外移会导致股骨假体过度外翻。术前应在全长或 14英寸× 17英寸站立正位X线画出股骨解剖轴线 ,根据股骨轴线与股骨髁交点的实际位置进行髓内定位 ,可减小误差     

A contemporary bicruciate total knee arthroplasty

Bicruciate retaining total knee arthroplasty dates back to the 1970s. The polycentric knee and the duocondylar spared the cruciate ligaments but led to early failures and loss of fixation. Designing surgeons excised the cruciates in order to facilitate the surgical procedure and improve the clinical results. Ultimately, the posterior cruciate sparing and substituting designs dominated the market. Most total knees are now anterior cruciate ligament deficient and 15–20% of patients are not satisfied with their surgical result. Bicruciate sparing total knee arthroplasties are now returning to the market and may afford improved results and satisfaction.     

Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty.

PURPOSES: The importance of the femoral sagittal bowing on total knee arthroplasty is under-recognized. The bowing could lead to potential errors in positioning of the femoral component if it is ignored. We aimed to document the femoral sagittal bowing at different segments of the Chinese femur and to discuss the implications of this sagittal bowing on total knee arthroplasty. METHODS: One hundred lateral radiographs of the entire lower limbs of 85 Chinese patients admitted for total knee arthroplasty were digitized. The radii of curvature of the intramedullary canal of the proximal, middle and distal one-third of the femora were measured. RESULTS: The average age of the patients was 67.3 years. The radii of curvature of the proximal, middle and distal one-third of the femora were 1081.6, 926.2 and 715.1 mm, respectively. The distal one-third of the femora was significantly more bowed than the other parts of the femora (p<0.001). The distal femoral bowing was more profound in rheumatoid patients and in those with a short femur. CONCLUSIONS: The lateral contour of the Chinese femur is like a hockey stick. This exaggerated sagittal bowing in the Chinese femur can affect the final sagittal position of the femoral component and has implications for the choice of implant design. In revision setting, a long and straight press-fit stem might either endanger the anterior cortex or deflect the femoral component to an abnormally extended position.     

膝表面置换术在类风湿性膝关节炎和骨性膝关节炎的应用和比较

目的探讨膝关节表面置换术治疗类膝关节风湿性关节炎(RA)和膝关节骨性关节炎(OA)的临床疗效、安全性差异。方法自2010-01—2012-04采用膝关节表面置换术治疗68例(84膝)膝关节疾患,按照疾病类型分为OA组和RA组,对比分析2组手术时间、术中出血量、VAS评分、切口愈合时间、HSS单项评分及总分等。结果术后68例(84膝)获得平均47个月随访,随访期间无人工膝关节假体脱位。OA组手术时间、术中失血量、术后引流量及VAS评分显著低于RA组,差异有统计学意义(P0.05)。OA组术后1个月疼痛和HSS总分显著高于RA组,差异有统计学意义(P0.05),OA组术后1年和3年疼痛、功能、活动范围单项评分和HSS总分均显著高于RA组,差异有统计学意义(P0.05)。结论OA及RA人工全膝置换术后功能均有一定改善,与OA相比,RA患者术后近中期疗效相对较差,但远期疗效差异有待进一步研究。     

Periprosthetic fractures around total knee arthroplasty

INTRODUCTION

The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function.

METHODS

A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified.

RESULTS

Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement.

CONCLUSIONS

Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon.     

Preoperative knee stiffness and total knee arthroplasty outcomes

A retrospective case-control study was conducted to evaluate 1-year total knee arthroplasty (TKA) outcomes among preoperative stiff knees, range of motion (ROM) 80° or less, compared with nonstiff preoperative knees, ROM 100° or greater. A total of 134 stiff knee cases were compared with a matched cohort of 134 non-stiff knee controls. Knee Society Score and Oxford Knee Score change scores from baseline to 1 year were similar between the groups. Stiff knees experienced a significantly greater mean improvement in ROM from baseline to 1 year (30.8° ± 18.8°) as compared with nonstiff knees (1.1° ± 12.8°) (P < .0001). Although ultimate ROM of a TKA can be restricted secondary to preoperative stiffness, improvements in outcomes and ROM are not affected. We conclude that progression of stiffness should not in and of itself lead to earlier intervention of TKA in most cases.     

Wound dehiscence after total knee arthroplasty

IntroductionWound dehiscence is one of the most common complications of surgical ulcer, involving the breaking open of the surgical incision along the stitch. This condition is a severe complication of total knee arthroplasty.Presentation of caseWe report a case of a 59-year-old female patient with diabetes who underwent a total knee arthroplasty in which all layers of wounds were dehiscence and prosthetic was exposed.DiscussionWound dehiscence is a complication after total knee arthroplasty especially in diabetic patient. So, patients with diabetes more susceptible to development of wound dehiscence following total knee arthroplasty and should be followed particularly postoperatively care.ConclusionPostoperative care after knee replacement should be more considered in diabetic patients. Finally the patient was successfully treated with irrigation and debridement (I&D) and polyethylene insert exchange.     

全膝关节置换术中下肢机械轴的研究进展

下肢机械轴(femorotibial mechanical axis,FTMA)是影响全膝关节置换术(total knee arthroplasty,TK A)后临床疗效的重要因素之一.通常认为TKA 后下肢力线对准范围控制在中性FTMA±3°之内,在改善关节功能、延长假体生存率及降低翻修率等更具优势,可获得到更好的临...     

68例人工膝关节置换术的临床特点分析

膝关节置换术在骨关节疾病中的应用非常广泛,我们针对本科到目前为止所作的68个膝关节置换术的临床特点进行分析.……