Jin Yan, Li Pingyue, Yang Yiming, Zeng Xianli, Shen Hongyuan, Zhang Lihang, Tsai Tsung-Yuan, Chen Jiarong
Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China.
Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Front Surg. 2022 Apr 27;9:872533. doi: 10.3389/fsurg.2022.872533. eCollection 2022.
The purpose of this study was to introduce a new reference axis for tibial rotation in total knee arthroplasty (TKA) and verify its reliability. A consecutive series of 80 knees that underwent TKA from 2018 to 2020 as well as 80 healthy knees were analyzed using a three-dimensional tibial model. A coordinate system was established based on the standard TKA tibial cut. The line connecting the lateral-tibial eminence and the medial 1/3rd of the tibial tubercle or the medial border of the tibial tubercle was identified as the lateral eminence line (LE line) and the medial lateral eminence line (MLE line), respectively. To evaluate the reliability of the new reference axis, Akagi's line, the medial third of the tibial tubercle (1/3 line) was compared with the LE and MLE lines by measuring the angle between the lines and the Z-axis. In the coronal view, the intersection angle (TPA), which is composed of the line connecting the center of the medial and lateral tibial plateau with the Z-axis, was measured. The mean angle between Akagi's line and the Z-axis in the healthy group and the osteoarthritis (OA) group was 87.57 ± 3.48° and 87.61 ± 3.47°, respectively. The mean angle between the LE line and Z-axis in the healthy and OA groups was 87.15 ± 4.13° and 86.78 ± 3.95°, respectively. A weak correlation was found between the TPA and Akagi's line and the 1/3 line. A moderate correlation was observed between the TPA and LE lines. There were no significant differences between the healthy and OA groups ( > 0.05) in any of the four reference axes. The LE line showed excellent intra- and inter-observer reliability and reproducibility. The novel and easily drawn LE line is a preferable option for tibial component rotational alignment in TKA.
本研究的目的是引入一种用于全膝关节置换术（TKA）中胫骨旋转的新参考轴，并验证其可靠性。使用三维胫骨模型分析了2018年至2020年连续接受TKA的80个膝关节以及80个健康膝关节。基于标准TKA胫骨截骨建立了一个坐标系。连接外侧胫骨髁和胫骨结节内侧1/3或胫骨结节内侧边界的线分别被确定为外侧髁线（LE线）和内侧外侧髁线（MLE线）。为了评估新参考轴（赤木线、胫骨结节内侧1/3（1/3线））的可靠性，通过测量各线与Z轴之间的角度，将其与LE线和MLE线进行比较。在冠状面上，测量由连接内侧和外侧胫骨平台中心的线与Z轴组成的相交角（TPA）。健康组和骨关节炎（OA）组中赤木线与Z轴之间的平均角度分别为87.57±3.48°和87.61±3.47°。健康组和OA组中LE线与Z轴之间的平均角度分别为87.15±4.13°和86.78±3.95°。发现TPA与赤木线和1/3线之间存在弱相关性。观察到TPA与LE线之间存在中度相关性。在四个参考轴中的任何一个上，健康组和OA组之间均无显著差异（>0.05）。LE线显示出极好的观察者内和观察者间可靠性及可重复性。这种新颖且易于绘制的LE线是TKA中胫骨组件旋转对线的更优选择。
