Sobczak Stéphane, Baillon Bruno, Feipel Véronique, Van Sint Jan Serge, Salvia Patrick, Rooze Marcel
Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculté de Médicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Surg Radiol Anat. 2011 Jul;33(5):439-49. doi: 10.1007/s00276-010-0753-y. Epub 2010 Dec 5.
Osteoarthritis (OA) of the knee is a degenerative disease mainly found in elderly population. Valgus deformity seems to be directly related to lateralised gonarthrosis. Contradictory outcomes of surgical series are published in the literature and report satisfactory and unsatisfactory long-term results. Lower limb torsions disorders have been considered as being another factor inducing gonarthrosis. This paper presents an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders (medial and lateral) and the deformation of the cancellous bone of the proximal tibial epiphysis (CB(TPE)).
Five left fresh-frozen lower limbs were used. Specimens were mounted on an experimental jig and muscles were loaded. Six measurement elements, including strain gages, were introduced into CB(TPE) to measure relative deformation. Experimental osteotomy control was performed using a specially devised system allowing various amplitudes of medial and lateral torsion. CB(TPE) deformations were measured during knee flexion movement.
Intra-observer reproducibility of CB(TPE) deformations showed a mean coefficient of multiple correlation of 0.93 and a mean coefficient of variation of 9% for flexion. Intra-specimen repeatability showed a mean RMS difference ranging from 7 to 10% and a mean ICC of 0.98. CB(TPE) deformations were significantly influenced by femoral torsion disorder conditions and range-of-motion (ROM) for most measurement elements. No interaction between torsion condition and ROM was observed. Globally, CB(TPE) deformation in the lateral compartment increased during experimental lateral torsion disorder simulation and decreased during medial torsion simulation. The opposite behaviour was observed in the medial compartment. The decrease and/or increase were not always proportional to the degree of femoral torsional disorder simulated.
Experimental results from this study do not fully agree with previously published clinical observations on the femoral torsion disorder. The present quantified results do not support that medial femoral torsion disorder induces an increased lateral tibial deformation, which could be linked to gonarthrosis observed in this compartment. In summary, our results showed that medial and lateral femoral torsion disorder conditions applied in normally aligned lower limb induced a deformation increase in the medial and in the lateral compartment, respectively.
膝关节骨关节炎（OA）是一种主要见于老年人群的退行性疾病。外翻畸形似乎与外侧膝关节病直接相关。文献中发表了手术系列的矛盾结果，报告了满意和不满意的长期结果。下肢扭转紊乱被认为是诱发膝关节病的另一个因素。本文介绍了一项体外研究，旨在量化实验性股骨扭转紊乱（内侧和外侧）与胫骨近端骨骺松质骨（CB(TPE)）变形之间的关系。
使用5条左下肢新鲜冷冻标本。将标本安装在实验夹具上并对肌肉加载。将包括应变片在内的6个测量元件植入CB(TPE)以测量相对变形。使用专门设计的系统进行实验性截骨控制，该系统允许进行不同幅度的内侧和外侧扭转。在膝关节屈曲运动期间测量CB(TPE)变形。
CB(TPE)变形的观察者内重复性显示，屈曲时的平均多重相关系数为0.93，平均变异系数为9%。标本内重复性显示，平均均方根差在7%至10%之间，平均组内相关系数为0.98。对于大多数测量元件，CB(TPE)变形受股骨扭转紊乱情况和活动范围（ROM）的显著影响。未观察到扭转情况与ROM之间的相互作用。总体而言，在实验性外侧扭转紊乱模拟期间，外侧间室的CB(TPE)变形增加，而在内侧扭转模拟期间减小。在内侧间室观察到相反的情况。减少和/或增加并不总是与模拟的股骨扭转紊乱程度成比例。
本研究的实验结果与先前发表的关于股骨扭转紊乱的临床观察结果不完全一致。目前的量化结果不支持股骨内侧扭转紊乱会导致胫骨外侧变形增加，而这可能与该间室中观察到的膝关节病有关。总之，我们的结果表明，在正常对线的下肢中施加内侧和外侧股骨扭转紊乱情况分别导致内侧和外侧间室的变形增加。
