两种股骨截骨角度对膝关节置换术中股骨假体冠状位对线的影响

发布时间：2019-03-09 11:53

【摘要】：[目的]研究两种股骨远端外翻截骨角测定方法在膝关节置换术中对股骨假体对线的影响。[方法]对本院2015年3月~2015年6月由两名主刀医师完成的连续111例共137膝全膝关节置换术进行回顾性研究。两名主刀医师术前计划时在下肢全长X线片上测量股骨远端外翻截骨角度的方法不同,并以此分为两组。第一组利用股骨远端1/3解剖轴与股骨力线轴夹角(DFMA)作为股骨远端外翻截骨角,共71膝;第二组利用股骨解剖轴与股骨力线轴夹角(FMA)进行外翻截骨,共66膝。术后测量标准下肢全长X线片中股骨力线轴与股骨假体远端内外侧髁连线之夹角并比较两组结果的差异。[结果]两组患者的年龄、BMI、术前内翻角度、术前HSS评分、术后HSS评分差异均无统计学意义(P=0.149~0.985)。DFMA组术中所使用的股骨外翻截骨角度实际为6.08°±1.57°,FMA组为4.82°±0.74°,两组截骨角度差异有统计学意义(P0.05)。DFMA组76.1%的术后股骨假体在0°±2°范围内,显著优于FMA组的51.50%,(P=0.005),并且DFMA组74.60%的术后下肢力线在0°±3°范围内,显著优于FMA组的53.00%,(P=0.008)。DFMA组术后下肢力线角度与FMA组差异无统计学意义(1.60°±2.46°vs 1.98°±3.35°,P=0.458)。[结论]内翻膝使用股骨远端1/3解剖轴与力线轴夹角作为个性化股骨外翻截骨角度,术后股骨假体冠状面位置优于使用股骨解剖轴与力线轴夹角。应用股骨解剖轴线确定股骨外翻截骨角度往往偏小,导致残留膝关节内翻畸形。
[Abstract]:[objective] to study the effect of two methods of osteotomy of distal femoral valgus on the line of femoral prosthesis in knee arthroplasty. [methods] from March 2015 to June 2015, 111 consecutive patients (137 knees) underwent total knee arthroplasty (TKR) from March 2015 to June 2015 in our hospital were retrospectively studied. Different methods were used to measure the osteotomy angle of distal femoral valgus on the full-length X-ray films of lower extremities, and were divided into two groups. In the first group, 71 knees were treated with the angle (DFMA) between the distal femoral anatomic axis and the femoral force axis, and in the second group, 66 knees were treated with the angle (FMA) between the femoral anatomical axis and the femoral force axis, and the angle between the femoral anatomic axis and the femoral force axis was used as the osteotomy angle of the distal femoral valgus in 71 knees in the first group and 66 knees in the second group. The angle between femoral force axis and distal and lateral condyle of femoral prosthesis was measured and the differences between the two groups were compared. [results] there was no significant difference in age, preoperative varus angle, preoperative HSS score, and postoperative HSS score between the two groups (P = 0.149 脳 0.985). DFMA). The osteotomy angle of femoral valgus was 6.08 掳卤1.57 掳in the group of P = 0.149 卤0.985). DFMA. The osteotomy angle in FMA group was 4.82 掳卤0.74 掳. There was significant difference in osteotomy angle between the two groups (P 0.05). (P 0.05) the femoral prosthesis in). DFMA group was within 0 掳卤2 掳, which was significantly higher than that in FMA group (51.50%, P < 0.005). The lower limb force line of DFMA group was significantly higher than that of FMA group within 0 掳卤3 掳(P < 0.05). (there was no significant difference between FMA group and). DFMA group (1.60 掳卤2.46 掳vs 1.98 掳卤3.35 掳, P = 0.458). The lower limb force line of FMA group was significantly higher than that of FMA group (1.60 掳卤2.46 掳vs 1.98 掳卤3.35 掳, P = 0.458). [conclusion] the angle between the distal femoral anatomic axis and the force line axis of the inverted knee is used as the individualized angle of femoral valgus osteotomy. The coronal position of the femoral prosthesis after operation is better than the angle between the anatomic axis of femur and the axis of force line. Using femoral anatomical axis to determine the osteotomy angle of femoral valgus is often small, resulting in residual varus deformity of the knee joint.
【作者单位】：第三军医大学;解放军总医院骨科;
【分类号】：R687.31

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