Whiteside L A, Arima J
Biomechanical Research Laboratory, Missouri Bone and Joint Center, St Louis, USA.
Clin Orthop Relat Res. 1995 Dec(321):168-72.
This study evaluated a technique using the anteroposterior axis of the distal femur, rather than the transepicondylar or posterior femoral condylar axis, to establish rotational alignment of the femoral component in valgus knees. The anteroposterior axis of the distal femur was defined by a line through the deepest part of the patellar groove anteriorly and the center of the intercondylar notch posteriorly. Total knee arthroplasty was done in 46 valgus knees between 1980 and 1986 using the posterior femoral condyles as landmarks for rotational alignment. From January 1986 through January 1992 total knee arthroplasty was done in 107 valgus knees using the anteroposterior axis for rotational alignment of the femoral component. In the group of knees using the posterior condylar axis, medial tibial tubercle transfer was needed intra-operatively in 8 knees to prevent lateral dislocation of the patella. In the first 2 postoperative years, 4 knees had recurrent patellar dislocation or subluxation that required surgical correction. In the group of knees using the anteroposterior axis, patellar tracking problems that required realignment were significantly reduced. One knee required medial tibial tubercle transfer to correct a Q angle > 20 degrees. In the remaining knees, the Q angle was < 10 degrees, and patellar tracking was acceptable. Two years after surgery, no knees had patellar instability.
本研究评估了一种技术，该技术使用股骨远端的前后轴而非经髁轴或股骨后髁轴来确定外翻膝关节中股骨假体的旋转对线。股骨远端的前后轴由一条从前侧髌槽最深部至后侧髁间切迹中心的线定义。1980年至1986年期间，对46例外翻膝关节进行了全膝关节置换术，使用股骨后髁作为旋转对线的标志。1986年1月至1992年1月期间，对107例外翻膝关节进行了全膝关节置换术，使用前后轴进行股骨假体的旋转对线。在使用后髁轴的膝关节组中，8例患者术中需要进行内侧胫骨结节转移以防止髌骨外侧脱位。术后头两年，4例患者出现复发性髌骨脱位或半脱位，需要手术矫正。在使用前后轴的膝关节组中，需要重新调整的髌骨轨迹问题显著减少。1例患者需要进行内侧胫骨结节转移以矫正Q角>20度。在其余膝关节中，Q角<10度，髌骨轨迹可接受。术后两年，无膝关节出现髌骨不稳定。
