Page Stephen R, Deakin Angela H, Payne Anthony P, Picard Frederic
Laboratory of Human Anatomy, University of Glasgow, Glasgow, United Kingdom.
Comput Aided Surg. 2011;16(2):86-92. doi: 10.3109/10929088.2011.552252. Epub 2011 Feb 4.
This study evaluated seven different frames of reference used for tibial component rotation in total knee arthroplasty (TKA) to determine which ones showed good reliability between bone specimens. An optoelectronic system based around a computer-assisted surgical navigation system was used to measure and locate 34 individual anatomical landmarks on 40 tibias. Each particular frame of reference was reconstructed from a group of data points taken from the surface of each bone. The transverse axis was used as the baseline to which the other axes were compared, and the differences in angular rotation between the other six reference frames and the transverse axis were calculated. There was high variability in the tibial rotational alignment associated with all frames of reference. Of the references widely used in current TKA procedures, the tibial tuberosity axis and the anterior condylar axis had lower standard deviations (6.1° and 7.3°, respectively) than the transmalleolar axis and the posterior condylar axis (9.3° for both). In conclusion, we found high variability in the frames of reference used for tibial rotation alignment. However, the anterior condylar axis and transverse axis may warrant further tests with the use of navigation. Combining different frames of reference such as the tibial tuberosity axis, anterior condylar axis and transverse axis may reduce the range of errors found in all of these measurements.
本研究评估了全膝关节置换术（TKA）中用于胫骨组件旋转的七种不同参考框架，以确定哪些在骨标本之间显示出良好的可靠性。使用基于计算机辅助手术导航系统的光电系统来测量和定位40根胫骨上的34个个体解剖标志点。每个特定的参考框架由从每块骨表面获取的一组数据点重建而成。以横轴作为比较其他轴的基线，并计算其他六个参考框架与横轴之间的角旋转差异。与所有参考框架相关的胫骨旋转对线存在高度变异性。在当前TKA手术中广泛使用的参考中，胫骨结节轴和髁前轴的标准差（分别为6.1°和7.3°）低于经踝轴和髁后轴（两者均为9.3°）。总之，我们发现用于胫骨旋转对线的参考框架存在高度变异性。然而，髁前轴和横轴可能值得使用导航进行进一步测试。结合不同的参考框架，如胫骨结节轴、髁前轴和横轴，可能会减少所有这些测量中发现的误差范围。
