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全膝关节置换术中股骨组件旋转对线的临床研究

A clinical study of the rotational alignment of the femoral component in total knee arthroplasty.

作者信息

Ding Liangjia, Liu Xiaomin, Liu Changlu, Liu Yingli

机构信息

Department of Joint Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, China.

Operation Room, The Second Affiliated Hospital of Inner Mongolia Medical University, China.

出版信息

J Phys Ther Sci. 2015 Jul;27(7):2077-81. doi: 10.1589/jpts.27.2077. Epub 2015 Jul 22.

Abstract

[Purpose] The reasons for femorotibial rotational malalignment after total knee arthroplasty (TKA) were analyzed to provide evidence for clinical knee joint surgery and to reduce complications. [Subjects and Methods] Ninety knees of 60 patients were selected and randomly divided into two groups (n=30). For one group, rotational alignment of the femoral component was determined by the transepicondylar axis and TKA was performed. For the other group, rotational alignment of the femoral component was conducted through 3° external rotation of the posterior femoral condyles. Knee joint specimens were operated with TKA and various biomechanical indices were measured. [Results] The femoral epicondylar axis was a constant, reliable reference for femoral component rotational alignment. When the femoral component was rotated by 0° versus the epicondylar axis, the peak contact pressure on the patellofemoral joint was optimal. When the femoral component was arranged in parallel with Whiteside's line, the peak contact pressure on the patellofemoral joint varied largely. The patellofemoral contact areas of the two groups were similar. [Conclusion] Axial rotational alignment of the femoral component influenced the contact pressure of patellofemoral joints in TKA more significantly than external rotation of the femoral condyles. It is more reliable to use the femoral epicondylar axis as the reference for the rotational alignment of the femoral component.

摘要

[目的] 分析全膝关节置换术(TKA)后股骨胫骨旋转排列不齐的原因,为临床膝关节手术提供依据并减少并发症。[对象与方法] 选取60例患者的90个膝关节,随机分为两组(n = 30)。一组通过经髁轴确定股骨组件的旋转排列并进行TKA;另一组通过股骨后髁外旋3°来确定股骨组件的旋转排列。对膝关节标本进行TKA手术并测量各种生物力学指标。[结果] 股骨髁上轴是股骨组件旋转排列的恒定、可靠参考。当股骨组件相对于髁上轴旋转0°时,髌股关节的峰值接触压力最佳。当股骨组件与Whiteside线平行排列时,髌股关节的峰值接触压力变化很大。两组的髌股接触面积相似。[结论] 在TKA中,股骨组件的轴向旋转排列比股骨髁外旋对髌股关节的接触压力影响更显著。以股骨髁上轴作为股骨组件旋转排列的参考更可靠。

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