在女性和内翻型骨关节炎膝关节全膝关节置换术中，关节软骨的存在对股骨部件旋转的影响。
Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees.
机构信息
Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea.
出版信息
J Orthop Surg Res. 2020 Oct 29;15(1):499. doi: 10.1186/s13018-020-02030-9.
PURPOSE
Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component.
METHODS
Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition.
RESULTS
In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness.
CONCLUSION
Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.
目的
全膝关节置换术（TKA）的手术技术需要股骨旋转矫正，这会改变膝关节后表面的位置，特别是在运动学对线中。然而，在不知道股骨软骨厚度的情况下，基于计算机断层扫描（CT）对 TKA 进行术前规划可能会导致股骨旋转术后失败。因此，本研究旨在评估后髁软骨厚度对股骨假体旋转对线的影响。
方法
对 139 名男性和 531 名女性骨关节炎患者进行三维磁共振成像（MRI）扫描。评估股骨后髁轴（PCA）和外科髁间轴（TEA）之间的角度，以确定是否存在软骨。此外，还评估了这些影响与患者性别和内翻/外翻情况的关系。
结果
在所有患者中，存在软骨时 TEA 与 PCA 之间的角度明显大于不存在软骨时。这一结果在女性患者中也存在。然而，在男性患者中，是否存在软骨对 TEA/PCA 角度没有影响。在女性内翻组中，存在软骨时 TEA/PCA 角度明显大于不存在软骨时。然而，在男性内翻/外翻组和女性外翻组中，是否存在软骨对 TEA/PCA 角度没有影响。在所有患者和男性患者中，股骨后髁的软骨厚度在外侧明显大于内侧。然而，在性别方面，软骨厚度没有差异。
结论
基于 CT 的 TKA 手术规划不考虑关节软骨，可能导致股骨植入物的外旋。因此，外科医生应考虑剩余的后髁软骨的影响，以防止股骨组件过度旋转，特别是在女性内翻膝。
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