Tetsworth K, Paley D
Division of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore.
Orthop Clin North Am. 1994 Jul;25(3):367-77.
The axial relationship of the joints of the lower extremity reflects both alignment and orientation. Static considerations are useful for preoperative planning and deformity correction, but dynamic considerations including compensatory gait may be more relevant clinically. Laboratory animal models have been developed that simulate the deleterious effect of malalignment on articular cartilage. Malalignment disturbs the normal transmission of force across the knee, and altered stress distribution related to deformity has been demonstrated in cadaver models using pressure-sensitive film. No prospective data are available to document the natural history of malalignment, but several retrospective studies suggest the clinical course is one of gradual progression resulting in degenerative arthropathy. The long-term follow-up of fractures is less definitive, and difficult to interpret considering the bias inherent in patient selection. Although direct clinical evidence of a cause-and-effect relationship between malalignment and arthrosis has not been possible, substantial evidence from the orthopedic literature supports this hypothesis.
下肢关节的轴向关系反映了对线和方向。静态因素对术前规划和畸形矫正有用，但包括代偿性步态在内的动态因素在临床上可能更具相关性。已经开发出实验室动物模型来模拟对线不良对关节软骨的有害影响。对线不良会干扰膝关节力的正常传递，并且在使用压敏膜的尸体模型中已经证明与畸形相关的应力分布改变。目前尚无前瞻性数据记录对线不良的自然病程，但几项回顾性研究表明，临床病程是逐渐进展并导致退行性关节病。骨折的长期随访结果不太明确，考虑到患者选择中固有的偏差，难以解释。虽然对线不良与关节病之间因果关系的直接临床证据尚不可能，但骨科文献中的大量证据支持这一假设。
