Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):451-457. doi: 10.1007/s00590-023-03672-1. Epub 2023 Aug 14.
We sought to define how changes in position and rotation of fluoroscopic imaging may affect the assessment of condylar widening intraoperatively.
Thirty-three patients with tibial plateau fractures were prospectively identified and included in this study. Fluoroscopic images of the uninjured tibial plateau were obtained in (1) full extension and (2) slight flexion on foam ramp. Beginning with a plateau view, additional views of the tibial plateau were then obtained by rotating the fluoroscope around the knee in 5 degree increments up to 15 degrees in both internal and external rotation. Measurements of distal femoral condylar width (DFW), distal femoral articular width (FAW), proximal tibial articular width (TAW) and lateral plateau width (LPW) were performed.
LPW was decreased in flexion compared to extension at all degrees of rotation (p = 0.04-0.00001). There was a trend toward increasing LPW with increasing degrees of internal rotation which reached significance at 15˚ of internal rotation when the knee was flexed. On ANOVA, there was a significant difference of LPW with increasing degree of internal rotation when the knee was in flexion (p = 0.008), but not in extension. There were no differences in DFW, FAW, TAW and DFW/TAW at any point though LPW was decreased in flexion at all degrees of rotation. The FAW/TAW ratio was increased in flexion at all degrees of rotation.
The knee in flexion will underestimate the measurement of condylar width compared to the knee in full extension, by ~ 2 mm. Rotation of the knee, in comparison, did not have a significant effect on condylar width assessment.
Diagnostic II.
我们旨在确定透视成像中位置和旋转的变化如何影响术中髁突增宽的评估。
前瞻性地确定了 33 例胫骨平台骨折患者，并将其纳入本研究。在泡沫斜坡上，获得未受伤胫骨平台的透视图像，包括（1）完全伸展和（2）轻度弯曲。首先拍摄平台视图，然后通过围绕膝关节以 5 度增量旋转透视机，在内外旋转 15 度内获得胫骨平台的附加视图。测量股骨远端髁宽度（DFW）、股骨远端关节面宽度（FAW）、胫骨近端关节面宽度（TAW）和外侧平台宽度（LPW）。
在所有旋转角度下，LPW 在弯曲时均低于伸展时（p=0.04-0.00001）。LPW 随内旋角度的增加而增加的趋势在膝关节弯曲时达到 15°的内旋时具有统计学意义。在 ANOVA 中，当膝关节弯曲时，LPW 随内旋角度的增加存在显著差异（p=0.008），但在伸展时则没有。尽管在所有旋转角度下 LPW 均降低，但 DFW、FAW、TAW 和 DFW/TAW 均无差异。在所有旋转角度下，FAW/TAW 比值在弯曲时均增加。
与完全伸展的膝关节相比，膝关节弯曲时的髁突宽度测量值会低估约 2mm。相比之下，膝关节的旋转对髁突宽度的评估没有显著影响。
诊断 II 级。
