徐石庄;郑欣;刘磊;杨冠杰;郭开今;赵凤朝;

• 1:徐州医科大学附属医院骨科

摘要(Abstract)：

[目的]探讨非负重位股骨全长片测量个性化股骨外翻角(VCA)截骨全膝关节置换对下肢和假体力线的影响。[方法] 2018年2月～2019年2月,126例(139膝)拟行初次全膝关节患者纳入本研究,采用随机数字表法将其分为两组。其中,63例(70膝)采用个性化非负重位测量VCA截骨TKA(个性化组);63例69膝采用固定VCA为6°截骨TKA(常规组)。记录围手术期资料;采用HSS膝关节评分评估膝关节功能;拍摄下肢负重位全长X线片,测量力线指标。[结果]两组患者手术顺利,均未发生严重并发症。个性化组70膝术前非负重股骨全长X线片上测量的个性化VCA的分布范围是3.40°～12.20°,平均(6.85±1.77)°,在5°～8°范围的比例为60.00%;负重位全长X线片上测量的VCA的分布范围3.40°～11.90°,平均(6.64±1.72)°,在5°～8°范围的比例为61.43%。非负重位与负重位全长X线片上VCA的差异有统计学意义(P<0.05)。非负重和负重状态下VCA的差异>1°的比例为20%。两组术后影像测量方面,个性化组的HKA角和FFC角显著大于常规组(P<0.05);但是,术后两组间FTC角的差异无统计学意义(P>0.05)。个性化组的HKA和FFC理想率显著高于常规组(P<0.05)。[结论]股骨外翻角变异性大,采用个性化股骨外翻角截骨较固定6°股骨外翻角截骨术后可获得更精确的下肢冠状面力线和股骨假体力线。

关键词(KeyWords)： 非负重位;个性化;外翻截骨角;全膝关节置换术;下肢力线

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（编号：81672184）;; 江苏省科委社会发展基金项目（编号：BE2016642）;; 江苏省医学重点人才基金项目（编号：WSN-065）

作者(Author): 徐石庄;郑欣;刘磊;杨冠杰;郭开今;赵凤朝;

Email:

DOI:

参考文献(References)：

• [1] Hirschmann M T, Karlsson J, Becker R. Hot topic:alignment in total knee arthroplasty-systematic versus more individualised alignment strategies[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6):1587-1588.
• [2] Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty[J]. Clin Orthop,1988, 232(232):168-173.
• [3] Hvid I, Nielsen S. Total condylar knee arthroplasty:prosthetic component positioning and radiolucent lines[J]. Acta Orthop, 1984,55(2):160-165.
• [4] Lampart M, Behrend H, Moser LB. Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation[J]. Knee Surg Sports Traumatol Arthroscopy, 2019, 27(5):1434-1441.
• [5] Palanisami D, Iyyampillai G, Shanmugam S, et al. Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity[J]. Int Orthop, 2016, 40(10):2049-2054.
• [6] Tan H, Wang Y, Long T, et al. How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty[J]. Int Orthop, 2018, 42(3):537-542.
• [7] Shi X, Li H, Zhou Z, et al. Individual valgus correction angle improves accuracy of postoperative limb alignment restoration after total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthroscopy, 2017, 25(1):277-283.
• [8] Maderbacher G, Baier C, Benditz A, et al. Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment[J]. Int Orthop,2017, 41(8):1553-1560.
• [9] Jamali AA, Meehan JP, Moroski NM, et al. Do small changes in rotation affect measurements of lower extremity limb alignment[J]. J Orthop Surg, 2017, 12(1):77.
• [10] Mullaji AB, Marawar SV. A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees[J]. J Arthroplasty, 2009, 24(6):861-867.
• [11] Cooke TD, Sled EA. Frontal plane knee alignment:a call for standardized measurement[J]. J Rheumatol, 2007, 34(9):1796-1801.
• [12] Lee CY, Huang TW, Peng KT, et al. Variability of distal femoral valgus resection angle in patients with end-stage osteoarthritis and genu varum deformity:radiographic study in an ethnic asian population[J]. Biomed J, 2015, 38(4):350-355.
• [13] Kinzel V, Scaddan M, Bradley B. Varus/valgus alignment of the femur in total knee arthroplasty can accuracy be improved by preoperative CT scanning[J]. Knee, 2004, 11(3):197-201.
• [14] Maderbacher G, Baier C, Springorum HR, et al. Impact of axial component alignment in total knee arthroplasty on lower limb rotational alignment:an in vitro study[J]. J Knee Surg, 2017, 30(4):372-377.