膝关节组成结构的临床解剖学研究

发布时间：2018-06-01 03:46

本文选题：全膝置换术 + 应用解剖　；参考：《河北医科大学》2006年博士论文

【摘要】： 1.胫骨近端、股骨远端和髌骨旋转关系的临床解剖学研究目的:通过对膝关节轴位MRI片上的测量,1)量化正常膝关节伸直时股骨上髁横轴(femoral epicondylar axis, FE)、股骨髁后缘轴线(posterior femoral axis, PF)、胫骨髁后缘轴线(posterior tibial axis, PT)、髌骨轴(patellar axis, PAT)之间的关系。2)确定在胫骨假体旋转对线中起定位作用的胫骨垫短轴与髌韧带(patellar ligament, PL)相交的位置。材料与方法:于MRI工作站的计算机平台上,在膝关节轴位MRI片上建立以下轴线:股骨上髁横轴(FE)、股骨髁后缘轴线(PF)、胫骨髁后缘轴线(PT)、髌骨横轴(PAT)、髌韧带轴(PL)。胫骨髁后缘轴线(PT)由胫骨平台后方内外侧骨皮质表面的连线形成,于胫骨平台关节软骨以远8mm的层面上获得。在同一层面建立髌韧带横轴(PL),它是由髌韧带内外侧缘连线形成。在显示股骨髁面积最大的层面上建立股骨上髁横轴(FE),它是通过股骨内、外上髁中心的连线。在同一层面可获得股骨髁后缘轴线(PF),它是由股骨内、外上髁后方的骨皮质表面的连线形成。髌骨横轴(PAT)是在髌骨长轴方向上,1/2髌骨的位置,由髌骨内、外侧透明软骨边缘的连线形成。测量上述四轴(PAT、FE、PF和PT)与髌韧带横轴(PL)间的夹角及相互间的夹角,用直线回归评定四轴之间的相关程度,并计算相关系数r和确定系数R2。为了确定TKA术中胫骨假体旋转定位的合适位置,首先拍摄Howmedica公司的假体胫骨垫模板(该假体为对称型设计,胫骨模板有6个型号),制成模板图片后,在工作站上成比例缩放和转动,使其长轴沿FE轴和PT轴分别安放,模板短轴(平分长轴宽度的垂线)前方与髌韧带各区相交点的分布数据可用作评价胫骨假体相对髌韧带旋转的量化指标。记录模板短轴前方与髌韧带的交点位置,用配对t检验比较交点位置的差异。结果:1)旋转轴间的相关性:FE轴和PAT轴明显相关(r2=0.70),
[Abstract]:1. Clinical anatomic study of the relationship between the proximal tibia, distal femur and patella rotation Objective: to quantify the relationship between femoral epicondylar axis, FEA, posterior femoral axis, posterior tibial axis of tibial condyle, patellar axis, and patellar axis of patellar axis during normal knee extension by measuring the axial position of knee joint on MRI film. The position of the intersection of the short axis of the tibial pad and patellar ligaments of patellar ligaments (PLs) in the rotation of the tibial prosthesis is determined. Materials and methods: on the computer platform of MRI workstation, the following axes were established on the knee joint axial MRI: femur epicondyle axis, femoral condyle posterior edge axis, tibial condyle posterior edge axis, patellar transverse axis, patellar ligament axis. The posterior edge axis of tibial condyle (PTT) was formed from the line of posterior and lateral cortical surface of tibial plateau and was obtained from the articular cartilage of tibial plateau on a far 8mm level. The transverse axis of patellar ligament was established on the same plane, which was formed by the line of inner and outer edge of patellar ligament. The transverse axis of the femoral epicondyle was established on the plane showing the largest area of the femoral condyle, which was connected through the center of the inner and outer epicondyle of the femur. The posterior edge axis of the femoral condyle can be obtained on the same plane, which is formed by the line of the cortical surface inside the femur and behind the external epicondyle. Patellar transverse axis (Pat) is a 1 / 2 position of patella in the long axis of patella, which is formed by the line of inner and lateral hyaline cartilage edge of patella. The angle and the angle between the four axes (FEPF and PTT) and the transverse PLs of the patellar ligament were measured. The correlation degree between the four axes was evaluated by linear regression, and the correlation coefficient r and the definite coefficient R2 were calculated. In order to determine the proper position of rotation positioning of tibial prosthesis during TKA, Howmedica's tibial pad template was first photographed. Scaled and rotated on the workstation in proportion to place the long axis along the FE axis and the PT axis, The distribution data of the intersecting points in front of the template short axis (vertical line with the width of the long axis) can be used as a quantitative index to evaluate the rotation of the tibial prosthesis relative to the patellar ligament. The position of the junction between the short axis of the template and the patellar ligament was recorded, and the difference of the position of the junction was compared by paired t test. Results: 1) the correlation between the rotation axis and the PAT axis is significantly related to the ratio FE axis to the PAT axis.
【学位授予单位】：河北医科大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R684;R322

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