髁间窝内侧壁在单间室膝关节置换术中作为胫骨旋转参考是否有用？
Is the medial wall of the intercondylar notch useful for tibial rotational reference in unicompartmental knee arthroplasty?
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
出版信息
Clin Orthop Relat Res. 2012 Apr;470(4):1177-84. doi: 10.1007/s11999-011-2138-x. Epub 2011 Oct 21.
BACKGROUND
It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique.
QUESTIONS/PURPOSES: We explored whether the medial wall of the intercondylar notch could be useful for the tibial rotational reference as an alternative to the AP axis in unicompartmental knee arthroplasty.
METHODS
We scanned the knees of 24 healthy Asian patients (45 knees) at a flexion angle of 90º using open MRI, then measured the angle between the AP axis and the medial wall of the notch. We determined whether the origins of the ACL and PCL were located lateral to the line on the medial wall of the notch and whether the mediolateral dimension of the bone cut surface of the medial tibial plateau was wide enough relative to the AP dimension to use the commercially available unicompartmental knee arthroplasty tibial components when the tibia was cut parallel to the medial wall of the notch.
RESULTS
At 90º flexion the medial wall of the notch was externally rotated 0.1º ± 4.4º relative to the AP axis. In all knees, the ACL and PCL were located lateral to the line on the medial wall of the notch. The mediolateral dimension of the bone cut surface was wide enough to use the commercially available tibial components.
CONCLUSIONS
At 90º flexion the medial wall of the intercondylar notch is almost parallel to the AP axis of the tibia at and we believe a reasonable candidate for a rotational reference of tibial placement in unicompartmental knee arthroplasty. This landmark would need to be confirmed in other populations and in patients with osteoarthritis.
背景
在单间膝关节置换术中，由于手术视野狭窄，很难将部件植入正确的旋转位置。尽管单间膝关节置换术尚未确定旋转参考，但胫骨的 AP 轴可作为单间膝关节置换术和 TKA 的参考。然而，在单间膝关节置换术中很难识别 AP 轴，尤其是采用胫骨初次截骨技术时。
问题/目的：我们探讨了在单间膝关节置换术中，作为 AP 轴的替代，髁间窝内侧壁是否可以作为胫骨旋转参考。
方法
我们在膝关节屈曲 90°的情况下使用开放式 MRI 对 24 名健康亚洲患者（45 膝）进行扫描，然后测量 AP 轴与髁间窝内侧壁之间的角度。我们确定 ACL 和 PCL 的起点是否位于髁间窝内侧壁上的线的外侧，以及当胫骨平行于髁间窝内侧壁截骨时，内侧胫骨平台的骨切面上的内外径相对于 AP 径是否足够宽，以使用市售的单间膝关节置换术胫骨部件。
结果
在膝关节屈曲 90°时，髁间窝内侧壁相对于 AP 轴外旋 0.1°±4.4°。在所有膝关节中，ACL 和 PCL 均位于髁间窝内侧壁上的线的外侧。骨切面上的内外径足够宽，可以使用市售的胫骨部件。
结论
在膝关节屈曲 90°时，髁间窝内侧壁几乎与胫骨的 AP 轴平行，我们认为它是单间膝关节置换术中胫骨放置旋转参考的合理候选者。这一标志需要在其他人群和骨关节炎患者中得到证实。
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