Sobczak S, Dugailly P-M, Baillon B, Lefevre P, Rooze M, Salvia P, Feipel V
Laboratory of Anatomy, Biomechanics and Organogenesis, Faculté de Médicine, Université Libre de Bruxelles, Bruxelles, Belgium.
Clin Biomech (Bristol). 2012 Dec;27(10):1011-6. doi: 10.1016/j.clinbiomech.2012.08.010. Epub 2012 Sep 13.
Gonarthrosis is a degenerative disease mainly found in elderly persons. Frontal plane deviations are known to induce lateral and medial gonarthrosis. Nevertheless, patients suffer from gonarthrosis without frontal deviations. Lower limb torsions disorders have been considered as a factor inducing lateral and medial gonarthrosis. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and femoro-tibial kinematics.
Five fresh-frozen lower limbs were used. Specimens were fixed on an experimental jig and muscles were loaded. A six-degree-of-freedom Instrumented Spatial Linkage was used to measure femoro-tibial kinematics. Experimental femoral osteotomies were performed to simulate various degrees of medial and lateral torsion. Internal tibial rotation, abduction/adduction and proximo-distal, medio-lateral and antero-posterior translations were measured during knee flexion.
Internal tibial rotation and abduction/adduction were significantly influenced (P<0.001) by femoral torsion disorder conditions. Medial femoral torsion increased tibial adduction and decreased internal rotation during knee flexion. Opposite changes were observed during lateral femoral torsion. Concerning translations, medial femoral torsion induced a significant (P<0.05) decrease of medial translation and inversely for lateral femoral torsion. No interactions between femoral torsion disorders and range of motion were observed.
Our results showed that medial and lateral femoral torsion disorders induced alterations of femoro-tibial kinematics when applied in normally aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on knee kinematics that may be related to the development of long-term knee disease.
膝关节骨性关节炎是一种主要见于老年人的退行性疾病。已知额状面偏差会导致外侧和内侧膝关节骨性关节炎。然而，有些患者患有膝关节骨性关节炎却没有额状面偏差。下肢扭转紊乱被认为是导致外侧和内侧膝关节骨性关节炎的一个因素。本文报告一项体外研究，旨在量化实验性股骨扭转紊乱与股胫运动学之间的关系。
使用5条新鲜冷冻下肢。将标本固定在实验夹具上并加载肌肉。使用六自由度仪器化空间连杆测量股胫运动学。进行实验性股骨截骨术以模拟不同程度的内旋和外旋。在膝关节屈曲过程中测量胫骨内旋、内收/外展以及近端-远端、内侧-外侧和前后向平移。
股骨扭转紊乱情况对胫骨内旋和内收/外展有显著影响（P<0.001）。股骨内旋在膝关节屈曲时增加胫骨内收并减少内旋。股骨外旋时观察到相反变化。关于平移，股骨内旋导致内侧平移显著减少（P<0.05），股骨外旋则相反。未观察到股骨扭转紊乱与运动范围之间的相互作用。
我们的结果表明，在正常对线的下肢中应用时，股骨内旋和外旋紊乱会导致股胫运动学改变。这些结果凸显了股骨扭转改变对膝关节运动学影响的潜在临床相关性，这可能与长期膝关节疾病的发展有关。
