股骨远端前后轴线的影像学研究及其临床意义

目的探讨股骨远端前后轴线在全膝关节置换术(TKA)中的临床应用价值。方法对86例106个无疾病的膝关节应用CT对股骨远端垂直于膝关节的机械轴进行薄层扫描,将获取的横断面图像输入电脑,用AutoCAD软件标识并测量、记录前后轴线与外科髁上轴的外侧夹角(ATA),前后轴线与后髁轴线的外侧夹角(APA),前后轴线的垂线与后髁轴线的夹角(A-PA),外科髁上轴与后髁轴线的夹角(PCA)。按性别和侧别分组,分析两组间各角度、比较ATA、APA与常数90°间以及A-PA与PCA、常数3°间有无统计学差异。结果 ATA为89.79°±1.22°,男性89.89°±1.10°,女性89.70°±1.34°,左侧89.63°±1.11°,右侧89.96°±1.32°。APA为84.84°±1.83°,男性84.96°±1.66°,女性84.72°±1.99°,左侧84.50°±2.03°,右侧85.19°±1.54°。A-PA为5.16°±1.83°,男性5.04°±1.66°,女性5.28°±1.99°,左侧5.50°±2.03°,右侧4.81°±1.54°。PCA为4.80°±1.23°,男性4.94°±1.24°,女性4.67°±1.21°,左侧4.87°±1.24°,右侧4.73°±1.22°。4角度性别间及侧别间比较差异均无统计学意义(P0.05)。常数90°与ATA比较差异无统计学意义(P0.05),与APA比较差异有统计学意义(P0.05);A-PA与PCA比较差异无统计学意义(P0.05),但二者与常数3°比较差异均有统计学意义(P0.05)。结论股骨远端的前后轴线可以作为股骨假体旋转对线的可靠标志。TKA中,股骨后髁的截骨在参照APL旋转定位时,应依据PCL外旋5°的方法才能获得满意的股骨假体旋转对线。

Study of imageology for anterior posterior line of the distal femur and its significance in total knee arthroplasty

Objective To explore clinical algnificance of anterior posterior line of distal femur on Chinese adults in to-tal knee arthroplasty（TKA）. Methods There were 86 adults,106 norlnal knees. The CT scan was elnployed in the distal fenur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the knee joint. The CT images of cross sections were moved to personal computer,then measured, ATA（ angle between anterior poste rior line and surgical transepicondylar axis）, APA（angle between anterior posterior line and posterior condylar line） , A PA（angle between perpendicularity of anterior posterior line and posterior condylar line）and PCA（ angle between surgical transepicondylar axis and posterior condylar line） using software of AutoCAD2007. When got the values,gave them a statistical analysis of gender and side and were compared statistically between ATA, APA and constant 90°, a mong with PCA ,A PA constant 3°with SPSS11. 0. the level of significance was P 〈 0. 05. Results ATA：89.79° ± 1.22°,male 89.89° ± 1.10°,female 89.70° ± 1.34°,left 89.63° ±1.11°,right 89.96° ± 1.32°. APA：84.84° ± 1.83°,inale 84.96° ± 1.66°,female 84.72° ± 1.99°,left 84.50° ± 2.03°,right 85.19° ± 1.54°. A PA：5.16° ± 1.83°,male 5.04° ± 1.66°,female 5.28° ± 1.99°,left 5.50° ± 2. 03°,right 4.81° ± 1.54°. PCA：4. 80° ± 1.23°, male 4.94° ± 1.24°,female 4.67° ± 1.21°,left 4.87° ± 1.24°,right 4.73° ± 1.22°. All the paralneters had no difference between sex and side knees,there was no difference between ATA and constant 90° ,but difference between APA and constant 90° were significant; there was no difference between A PA and PCA,but difference between PCA, A PA and constant 3° were significant. Condusions The anterior posterior line of distal felnur lnay be considered a reliable mark of rotational alignment in TKA. So in the TKA, the section of femoral posterior condyle should be exter-nal 5° to the posterior condylar line according to anterior posterior line of distal femur to obtain the optilnUln rotational orientation.