CT扫描在全膝关节置换术中髌股关节轨迹不良股骨旋转力线的研究
潘永谦;李健;张平;莫婉兰;王簕;钟志宏;
摘要(Abstract)：
[目的]探讨CT扫描技术检测全膝关节置换术(TKA)中对髌股关节轨迹不良股骨旋转截骨角度确定的作用。[方法]将72例(74膝)TKA中髌股关节轨迹不良患者随机分为两组:(1)CT扫描组35例(36膝):术前CT扫描确定股骨后髁角,术中采用CT确定的股骨后髁角进行股骨外旋截骨,其余TKA手术操作相同;(2)对照组37例(38膝):术中采用与后髁轴线呈固定外旋3°进行股骨外旋截骨,两组术后均行CT扫描分析股骨假体旋转不良角度并对其绝对值进行比较。[结果]术后随访时间24~120个月,平均53.6个月。CT扫描组KSS功能评分从术前的平均35分提高到术后平均81分;对照组KSS功能评分从术前的平均34分提高到术后平均83分,两组比较均无显著性差异(P>0.05)。CT扫描组:TKA术后股骨假体旋转不良角度为1.4°±0.06°,对照组为2.5°±0.14°,两组比较差异有统计学意义(t=4.18,P<0.01)。CT扫描组股骨假体旋转不良率为12.5%,经验组为24.6%,两组比较差异有统计学意义(x2=16.58,P<0.01)。[结论]术前CT扫描确定股骨假体旋转参考轴,可用于指导全膝关节置换术中股骨旋转截骨角度,有效提高TKA手术股骨假体旋转力线的准确性。
关键词(KeyWords)： 全膝关节置换;股骨假体;髌股关节;旋转力线
基金项目(Foundation): 广东省医学科研基金立项课题(编号:A2013282)
作者(Author): 潘永谦;李健;张平;莫婉兰;王簕;钟志宏;
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DOI:
参考文献(References)：
- [1]Eisenhuth SA,Salch KJ,Cui Q,et al.Patellofemoral instability after total knee arthroplasty[J].Clin Orthop,2006,446:149-160.
- [2]Endres S,Endres N,Lappas K,et al.Patellar instability[J].Sportverletz Sportschaden,2006,4:184-191.
- [3]潘永谦,李健,杨波,等.全膝关节置换术中髌股关节轨迹不良的处理[J].中国组织工程研究,2013,17:2327.
- [4]Figgie M,Goldberg V,Figgie H.Salvage of the symptomatic patellofemoral joint following cruciate substituting total knee arthroplasty[J].Am J Knee Surg,1988,1:48-55.
- [5]Merkow RL,Soudry M,lnsall J.Patellar dislocation following total knee replacement[J].J Bone Joint Surg Am,1985,9:1321-1326.
- [6]Ranawat C.The patellofemoral joint in total condylar arthroplasty:pros and cons based on five to ten year follow-up observations[J].Clin Orthop,1986,205:93-99.
- [7]Briard JL,Hungerfond DS.Patellofemoral instability in total knee arthroplasty[J].J Arthroplasty,1989,4:87-97.
- [8]Heergaard JH,Horey CB.A computer model to simulate patellar biomechanics folloowing total knee replace:the effects of femoral component alignment[J].Clin Biomech,2001,16:415-423.
- [9]孙振辉,刘军,田峥巍,等.间隙平衡技术在全膝关节置换术中应用的中期随访研究[J].中国矫形外科杂志,2013,13:1292-1296.
- [10]张华山,翁文杰,蒋青.正常成人股骨远端后髁角的测量及临床意义[J].中华骨科杂志,2006,4:252-255.
- [11]Yip DKH,Zhu YH,Chiu KY,et al.Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty[J].J Arthroplasty,2004,5:613-619.
- [12]周殿阁,吕厚山,方竞,等.膝关节侧副韧带解剖特点与膝关节置换股骨假体旋转定位轴位的关系[J].中国修复重建外科杂志,2006,6:594-597.
- [13]梁兴森,余正红,李义凯.髌股关节稳定机制的解剖学及生物力学研究现状[J].颈腰痛杂志,2008,3:260-262.