全膝关节置换术不同股骨后髁偏心距对术后膝关节最大屈曲度影响的初步基础研究
发布时间：2019-04-01 23:07
【摘要】：目的全膝关节置换术是治疗终末期膝骨关节炎的有效方法,术后膝关节良好的屈曲度是手术成功及患者满意的一个重要方面。影响膝关节置换术后膝关节屈曲度的因素是多方面的,其中股骨后髁偏心距(posterior condylar offset)最早由Bellemans等在2002年提出,近年来,股骨后髁偏心距对膝关节屈曲度的影响多有报道,其对膝关节屈曲度的影响具有一定争议。理论上,股骨后髁偏心距越大,在膝关节屈曲过程中胫骨平台后缘与股骨后侧骨皮质发生撞击越晚,膝关节屈曲角度越大。本次初步研究应用基础实验,探讨股骨后髁偏心距与膝关节置换术后膝关节最大屈曲度的关系。方法实验用福尔马林固定的人体下肢6具,长度自髋关节离断至足(包括足),其中男性4具,女性2具,膝关节外形均未见明显疤痕及畸形,屈伸活动自如;实验用假体选用强生De Puy PFC SIGMA PS假体固定平台系统,股骨侧试模选用常用型号2、2.5、3、4;胫骨侧依据测量大小选用试模;半月板厚度包括8mm、10mm、12.5mm、15mm、17.5mm和1mm厚度垫片;实验用骨水泥选用有机胶泥替代。手术操作常规行内侧髌旁入路暴露膝关节,先行股骨侧截骨:股骨远端等量截骨9mm,选用前参考系统,将股骨测量导板导针定位于股骨远端外侧皮质齐平,拧紧尺寸指示刻度,移动钻头导向刻度,分别定位于2、2.5、3、4,外旋3°在导板导钉孔依次打入导钉,股骨侧按实际测量大小完成斜面截骨、髁间截骨;胫骨侧专用器械完成平台截骨,8mm间隙块测量屈伸间隙相等;安装实际股骨侧及胫骨侧试模假体,选用8mm半月板,极度屈曲膝关节摄最大屈曲纯侧位1:1 X线片,划线测量并记录股骨后髁偏心距数值及最大膝关节屈曲度数值;再分别由小至大安装其余型号股骨侧截骨板对应之导板钉孔标记,分别完成斜面截骨、髁间截骨,再分别按照不同股骨髁假体测量数据a(见图1)之间差异,选择相应胫骨侧加截骨数值或选用加厚胫骨平台半月板型号,保证屈曲间隙恒定为8mm,应用不同型号膝关节股骨侧假体并极度屈曲膝关节摄最大屈曲纯侧位1:1 X线片,测量并记录股骨后髁偏心距、膝关节最大屈曲角度数值,进行统计学分析。结果6具标本术前与术中采用不同型号股骨侧假体股骨后髁偏心距数值和术前与术中采用不同型号股骨侧假体膝关节最大屈曲度数值经Pearson相关系数和Spearman相关系数检验,同一标本不同股骨髁偏心距与术后膝关节最大屈曲度并无相关性(均P0.05,差异无统计学意义)。结论通过本组实验,我们认为全膝关节置换术股骨后髁偏心距大小与术后膝关节最大屈曲度无相关性。
[Abstract]:Objective Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthritis. The good flexion of the knee after operation is an important aspect of the success and satisfaction of the patients. There are many factors affecting knee flexion after knee replacement. The eccentricity of femoral posterior condyle (posterior condylar offset) was first proposed by Bellemans et al in 2002. In recent years, the influence of femoral posterior condylar eccentricity on knee flexion has been reported. Its influence on knee flexion is controversial. Theoretically, the greater the eccentricity of the femoral posterior condyle, the later the impact occurs between the posterior edge of the tibial plateau and the posterior femoral bone cortex, and the greater the flexion angle of the knee joint is. In this preliminary study, the relationship between femoral posterior condylar eccentricity and the maximum flexion of knee joint after knee arthroplasty was studied. Methods six lower limbs were fixed with formalin. The length was from hip joint to foot (including foot). There were 4 males and 2 females. There were no obvious scars and deformities in the knee joint, and the movement of flexion and extension was free. The fixed platform system of Johnson De Puy PFC SIGMA PS prosthesis was used in the experiment, and the femoral side test model was chosen as the usual type 2, 2.5, 3, 4. The tibial side was tested according to the measuring size. Meniscus thickness includes 8mm, 10mm, 12.5mm, 15mm, 17.5mm and 1mm thickness gasket. During the operation, the knee joint was exposed through the medial paratellar approach, and the femoral lateral osteotomy was performed first: the distal femur osteotomy was equal to 9 mm. The anterior reference system was used to locate the femoral measurement guide pin in the lateral cortex of the distal femur and tighten the size indicator scale. The guide scale of the moving bit was fixed at 2,2.5, 3,4 and external rotation 3 掳into the guide pin hole in turn, and the femoral side was osteotomy on the oblique surface and intercondylar osteotomy according to the actual size of the femur. Tibial side special instrument completed platform osteotomy, 8mm space block measurement flexion and extension gap is equal; The 8mm meniscus was used to measure the maximum flexion of knee joint at 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion of knee joint were measured and recorded. From small to large, the other types of femoral lateral osteotomy plate corresponding to the guide plate pinhole marking, respectively completed oblique osteotomy, intercondylar osteotomy, and then according to different femoral condylar prosthesis measured data a (see fig. 1), the difference between the different femoral condylar prosthesis measured data a (see fig. 1). Select the corresponding tibial side plus osteotomy value or thickened tibial plateau meniscus type to ensure a constant buckling gap of 8 mm, using different types of knee femoral prosthesis and extreme flexion of the knee joint to take the maximum flexion of the pure lateral position 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion angle of knee joint were measured and recorded for statistical analysis. Results the eccentricity of femoral posterior condyle with different types of femoral prosthesis and the maximum flexion of knee joint with different types of femoral prosthesis were tested by Pearson correlation coefficient and Spearman correlation coefficient before and after operation. There was no correlation between the eccentricity of different femoral condyles and the maximum flexion of knee joint after operation (all P 0.05, there was no significant difference between the two groups). Conclusion there is no correlation between the eccentricity of the femoral posterior condyle and the maximum flexion of the knee after total knee arthroplasty.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2451993
[Abstract]:Objective Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthritis. The good flexion of the knee after operation is an important aspect of the success and satisfaction of the patients. There are many factors affecting knee flexion after knee replacement. The eccentricity of femoral posterior condyle (posterior condylar offset) was first proposed by Bellemans et al in 2002. In recent years, the influence of femoral posterior condylar eccentricity on knee flexion has been reported. Its influence on knee flexion is controversial. Theoretically, the greater the eccentricity of the femoral posterior condyle, the later the impact occurs between the posterior edge of the tibial plateau and the posterior femoral bone cortex, and the greater the flexion angle of the knee joint is. In this preliminary study, the relationship between femoral posterior condylar eccentricity and the maximum flexion of knee joint after knee arthroplasty was studied. Methods six lower limbs were fixed with formalin. The length was from hip joint to foot (including foot). There were 4 males and 2 females. There were no obvious scars and deformities in the knee joint, and the movement of flexion and extension was free. The fixed platform system of Johnson De Puy PFC SIGMA PS prosthesis was used in the experiment, and the femoral side test model was chosen as the usual type 2, 2.5, 3, 4. The tibial side was tested according to the measuring size. Meniscus thickness includes 8mm, 10mm, 12.5mm, 15mm, 17.5mm and 1mm thickness gasket. During the operation, the knee joint was exposed through the medial paratellar approach, and the femoral lateral osteotomy was performed first: the distal femur osteotomy was equal to 9 mm. The anterior reference system was used to locate the femoral measurement guide pin in the lateral cortex of the distal femur and tighten the size indicator scale. The guide scale of the moving bit was fixed at 2,2.5, 3,4 and external rotation 3 掳into the guide pin hole in turn, and the femoral side was osteotomy on the oblique surface and intercondylar osteotomy according to the actual size of the femur. Tibial side special instrument completed platform osteotomy, 8mm space block measurement flexion and extension gap is equal; The 8mm meniscus was used to measure the maximum flexion of knee joint at 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion of knee joint were measured and recorded. From small to large, the other types of femoral lateral osteotomy plate corresponding to the guide plate pinhole marking, respectively completed oblique osteotomy, intercondylar osteotomy, and then according to different femoral condylar prosthesis measured data a (see fig. 1), the difference between the different femoral condylar prosthesis measured data a (see fig. 1). Select the corresponding tibial side plus osteotomy value or thickened tibial plateau meniscus type to ensure a constant buckling gap of 8 mm, using different types of knee femoral prosthesis and extreme flexion of the knee joint to take the maximum flexion of the pure lateral position 1:1 X-ray. The eccentricity of femoral posterior condyle and the maximum flexion angle of knee joint were measured and recorded for statistical analysis. Results the eccentricity of femoral posterior condyle with different types of femoral prosthesis and the maximum flexion of knee joint with different types of femoral prosthesis were tested by Pearson correlation coefficient and Spearman correlation coefficient before and after operation. There was no correlation between the eccentricity of different femoral condyles and the maximum flexion of knee joint after operation (all P 0.05, there was no significant difference between the two groups). Conclusion there is no correlation between the eccentricity of the femoral posterior condyle and the maximum flexion of the knee after total knee arthroplasty.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【共引文献】
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