Ariumi Akihiro, Sato Takashi, Kobayashi Koichi, Koga Yoshio, Omori Go, Minato Izumi, Endo Naoto
Department of Orthopaedic Surgery, Niigata Kobari Hospital, Kobari, Niigata, Japan.
J Orthop Sci. 2010 Jan;15(1):64-70. doi: 10.1007/s00776-009-1414-z. Epub 2010 Feb 12.
Although assessment of lower extremity alignment is important for the treatment and evaluation of diseases that present with malalignment of the lower extremity, it has generally been performed using only plain radiographs seen in two dimensions (2D). In addition, there is no consensus regarding the criteria for quantitative three-dimensional (3D) evaluation of the relative angle between the femur and tibia. The purpose of this study was to establish assessment methods and criteria for quantitatively evaluating lower extremity alignment in 3D and to obtain reference data from normal elderly subjects.
The normal alignment of 82 limbs of 45 healthy elderly subjects (24 women, 21 men; mean age 65 years, range 60-81 years) was analyzed in 3D with regard to flexion, adduction-abduction, and rotational angle of the knee in the weight-bearing, standing position. The obtained computed tomography (CT) and biplanar computed radiography (CR) data were used to define several anatomical axes of the femur and tibia as references.
In the sagittal plane, the mean extension-flexion angle was significantly more recurvatum in women than in men. In the coronal plane, the mean 3D hip-knee-ankle angle was more varus by several degrees in this Japanese series than that in a Caucasian series reported previously. Regarding rotational alignment, the mean angle between the anteroposterior axis of the tibia and the transepicondylar axis of the femur in this series was slightly larger (externally rotated) than that of previously reported Japanese series examined in the supine position.
These data are believed to represent important references for 3D evaluation of morbid lower extremity alignment in the weight-bearing, standing position and are important for biomechanical research (e.g., 3D analyses of knee kinematics) because the relative angles between the femur and tibia are assessed three-dimensionally.
尽管评估下肢对线对于治疗和评估存在下肢对线不良的疾病很重要，但通常仅使用二维（2D）的普通X线片进行评估。此外，关于股骨和胫骨相对角度的定量三维（3D）评估标准尚无共识。本研究的目的是建立定量评估三维下肢对线的方法和标准，并从正常老年受试者中获取参考数据。
对45名健康老年受试者（24名女性，21名男性；平均年龄65岁，范围60 - 81岁）的82条下肢在负重站立位时膝关节的屈曲、内收外展和旋转角度进行三维分析。所获得的计算机断层扫描（CT）和双平面计算机X线摄影（CR）数据被用于定义股骨和胫骨的几个解剖轴作为参考。
在矢状面，女性的平均伸展 - 屈曲角度比男性明显更呈后凸。在冠状面，本日本队列中三维髋 - 膝 - 踝角比先前报道的白种人队列内翻几度。关于旋转对线，本队列中胫骨前后轴与股骨髁上轴之间的平均角度比先前报道的仰卧位检查的日本队列略大（外旋）。
这些数据被认为是负重站立位病态下肢对线三维评估的重要参考，并且对于生物力学研究（例如膝关节运动学的三维分析）很重要，因为股骨和胫骨之间的相对角度是三维评估的。
