基于CT三维重建测量膝关节骨关节炎患者股骨远段前偏角的初步研究
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摘要
目的初步研究膝关节骨关节炎患者股骨远段前偏角度(distal femoral sagittal anterior angle,DFSAA)规律,探讨其对股骨侧假体位置安放的影响。方法收集2017年1月至2018年1月共131例膝关节骨关节炎拟行全膝关节置换术患者病例。术前行双下肢全长CT扫描获得股骨的3D图像,应用Mimics 17.0软件测量每个股骨的DFSAA(共262个),进行统计分析,并做男女比较和左右比较。术后行膝关节标准侧位片,记录股骨前侧皮质切迹notch的发生例数。结果平均DFSAA度数为(2.51±1.50)°,最小为0.05°,最大5.74°;男性平均(2.58±1.59)°,女性平均(2.50±1.49)°,男性和女性组间比较差异无统计学意义(t检验,P=0.389);每个患者的左右DFSAA最小的相差0.01°,最大的相差3.08°,平均为1.039 7°,90%的患者相差在2°以内。DFSAA≤3°notch发生率4.48%;DFSAA>3°notch发生率18.37%,两组比较差异有统计学意义(χ2检验,P=0.028)。结论股骨远段前偏角在膝关节骨关节炎患者中有差异,在全膝置换术前应考虑DFSAA大小。对于DFSAA>3°的患者,推荐参考解剖轴线截骨;对于DFSAA<3°的患者推荐参考机械轴线截骨。
Objective To analyze the laws of distal femoral sagittal anterior angle(DFSAA)in the patients with knee osteoarthritis preliminary and to discuss the influence that DFSAA will have on the location of the femoral component installation after total knee arthroplasty. Methods The data of 131 patients who took knee arthroplasty between January 2017 and January 2018 were collected.The 3 Dimages of bilateral femurs were acquired by CT full-length scan of bilateral lower limbs,then the DFSAA of 262 femurs were measured separately with Mimics 17.0 software and also analyzed statistically,and finally the measurement results were compared between males and females and between the left side and the right side. Results The DFSAA was(2.51±1.50)°(0.05°～5.74°)on average;it was(2.58±1.59)°in males and(2.50±1.49)°in females,and the difference between males and females was not significant(t-test,P>0.05).For individual patients,the difference of DFSAA between the left side and the right side was 1.039 7°on average(0.01°～3.08°);and it was less than 2°in 90% patients.When the value of DFSAA was 3°or less,the incidence of the notch was 4.48%.When the value of DFSAA was greater than 3°,the incidence of the notch was 18.37%;there were differences between the two groups to compare(chi-square test,P=0.028). Conclusion The value of DFSAA varies among the patient with knee osteoarthritis,which should be considered before total knee arthroplasty.For patient with DFSAA value more than 3°,anatomic-axis osteotomy is recommended;for patient with DFSAA value less than 3°,mechanical-axis osteotomy is recommended.
Objective To analyze the laws of distal femoral sagittal anterior angle(DFSAA)in the patients with knee osteoarthritis preliminary and to discuss the influence that DFSAA will have on the location of the femoral component installation after total knee arthroplasty. Methods The data of 131 patients who took knee arthroplasty between January 2017 and January 2018 were collected.The 3 Dimages of bilateral femurs were acquired by CT full-length scan of bilateral lower limbs,then the DFSAA of 262 femurs were measured separately with Mimics 17.0 software and also analyzed statistically,and finally the measurement results were compared between males and females and between the left side and the right side. Results The DFSAA was(2.51±1.50)°(0.05°～5.74°)on average;it was(2.58±1.59)°in males and(2.50±1.49)°in females,and the difference between males and females was not significant(t-test,P>0.05).For individual patients,the difference of DFSAA between the left side and the right side was 1.039 7°on average(0.01°～3.08°);and it was less than 2°in 90% patients.When the value of DFSAA was 3°or less,the incidence of the notch was 4.48%.When the value of DFSAA was greater than 3°,the incidence of the notch was 18.37%;there were differences between the two groups to compare(chi-square test,P=0.028). Conclusion The value of DFSAA varies among the patient with knee osteoarthritis,which should be considered before total knee arthroplasty.For patient with DFSAA value more than 3°,anatomic-axis osteotomy is recommended;for patient with DFSAA value less than 3°,mechanical-axis osteotomy is recommended.
引文
[1]Tibbo ME,Wyles CC,Houdek MT,et al.Outcomes of primary total knee arthroplasty in patients with Ehlers-Danlos[J].J Arthroplasty,2019,34(2):315-318.
[2]Berend M.Consequences of malalignment in total knee arthroplasty:Few if Any-Opposes[J].Semin Arthroplasty,2010,21(2):99-101.
[3]Meric G,Gracitelli GC,Aram LJ,et al.Variability in distal femoral anatomy in patients undergoing total knee arthroplasty:measurements on 13,546computed tomography scans[J].J Arthroplasty,2015,30(10):1835-1838.
[4]Chung BJ,Kang YG,Chang CB,et al.Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA[J].Clin Orthop Relat Res,2009,467(9):2403-2413.
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[6]Choong PF,Dowsey MM,Stoney JD.Does accurate anatomical alignment result in better function and quality of life?Comparing conventional and computer-assisted total knee arthroplasty[J].J Arthroplasty,2009,24(4):560-569.
[7]Bao Z,Qiao L,Qin J,et al.The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis-a radiographic analysis[J].J Orthop Surg Res,2017,12(1):127.
[8]Kim JM,Hong SH,Kim JM,et al.Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape[J].Knee Surg Sports Traumatol Arthrosc,2015,23(7):1936-1942.
[9]Shi X,Li H,Zhou Z,et al.Comparison of postoperative alignment using fixed vs individual valgus correction angle in primary total knee arthroplasty with lateral bowing femur[J].J Arthroplasty,2016,31(5):976-983.
[10]Wu PH,Zhang ZQ,Gu MH,et al.Radiographic measurement of femoral lateral bowing and distal femoral condyle resection thickness:Variances and effects on total knee srthroplasty planning[J].Zhonghua Yixue Zazhi,2017,130(21):2557-2562.
[11]Wu W,Guo WS,Cheng LM,et al.Individual difference of coronal bowing of femur and its influence on the lower limbs alignment after the total knee arthroplasty[J].Zhonghua Yixue Zazhi,2017,97(13):1006-1010.
[12]Tang WM,Chiu KY,Kwan MFY,et al.Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty[J].J Orthop Surg Res,2010,23(1):41-45.
[13]Lu ZH,Yu JK,Chen LX,et al.Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50years[J].J Arthroplasty,2012,27(6):1216-1220.
[14]Nakahara H,Matsuda S,Okazaki K,et al.Sagittal cutting error changes femoral anteroposterior sizing in total knee arthroplasty[J].Clin Orthop Relat Res,2012,470(12):3560-3565.
[15]Akamatsu Y,Kobayashi H,Kusayama Y,et al.Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis:a comparison with radiograph and its predictive factors[J].Arch Orthop Trauma Surg,2016,136(9):1-6.
[16]Abdelaal A,Yamamoto N,Hayashi K,et al.Radiological assessment of the femoral bowing in Japanese population[J].SICOT J,2016,22(2):2.
[17]Kazemi SM,Shafaghi T,Minaei R,et al.The effect of sagittal femoral bowing on the femoral component position in total knee arthroplasty[J].Arch Bone Jt Surg,2017,5(4):250-254.
[18]Shawen SB,Belmont PJ Jr,Klemme WR,et al.Osteoporosis and anterior femoral notching in periprosthetic supracondylar femoral fractures:a biomechanical analysis[J].J Bone Joint Surg(Am),2003,85(1):115-121.
[19]Ma R,Ae T,Em K,et al.The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome[J].J Bone Joint Surg(Am),2005,87(11):2411-2414.
[20]孙云波,刘军,田峥巍,等.全膝关节置换股骨切迹发生因素分析及远期随访研[J].中国矫形外科杂志,2011,279(13):1073-1076.
[21]Li Y,Tian H,Geng X.Effect of the surgical time and coronalmechanical alignment after total knee arthroplasty using computer navigation system,traditionalor 3D printing patient-specific instruments[J].Zhonghua Yixue Zazhi,2018,98(27):2157-2161.
[22]Trudell MB.Anterior femoral curvature revisited:race assessment from the femur[J].J Forensic Sci,1999,44(4):700-707.
[2]Berend M.Consequences of malalignment in total knee arthroplasty:Few if Any-Opposes[J].Semin Arthroplasty,2010,21(2):99-101.
[3]Meric G,Gracitelli GC,Aram LJ,et al.Variability in distal femoral anatomy in patients undergoing total knee arthroplasty:measurements on 13,546computed tomography scans[J].J Arthroplasty,2015,30(10):1835-1838.
[4]Chung BJ,Kang YG,Chang CB,et al.Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA[J].Clin Orthop Relat Res,2009,467(9):2403-2413.
[5]Weber KL,Jevsevar DS,Mcgrory BJ.AAOS clinical practice guideline:Surgical management of osteoarthritis of the knee:evidence-based guideline[J].J Am Acad Orthop Surg,2016,24(8):e94-96.
[6]Choong PF,Dowsey MM,Stoney JD.Does accurate anatomical alignment result in better function and quality of life?Comparing conventional and computer-assisted total knee arthroplasty[J].J Arthroplasty,2009,24(4):560-569.
[7]Bao Z,Qiao L,Qin J,et al.The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis-a radiographic analysis[J].J Orthop Surg Res,2017,12(1):127.
[8]Kim JM,Hong SH,Kim JM,et al.Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape[J].Knee Surg Sports Traumatol Arthrosc,2015,23(7):1936-1942.
[9]Shi X,Li H,Zhou Z,et al.Comparison of postoperative alignment using fixed vs individual valgus correction angle in primary total knee arthroplasty with lateral bowing femur[J].J Arthroplasty,2016,31(5):976-983.
[10]Wu PH,Zhang ZQ,Gu MH,et al.Radiographic measurement of femoral lateral bowing and distal femoral condyle resection thickness:Variances and effects on total knee srthroplasty planning[J].Zhonghua Yixue Zazhi,2017,130(21):2557-2562.
[11]Wu W,Guo WS,Cheng LM,et al.Individual difference of coronal bowing of femur and its influence on the lower limbs alignment after the total knee arthroplasty[J].Zhonghua Yixue Zazhi,2017,97(13):1006-1010.
[12]Tang WM,Chiu KY,Kwan MFY,et al.Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty[J].J Orthop Surg Res,2010,23(1):41-45.
[13]Lu ZH,Yu JK,Chen LX,et al.Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50years[J].J Arthroplasty,2012,27(6):1216-1220.
[14]Nakahara H,Matsuda S,Okazaki K,et al.Sagittal cutting error changes femoral anteroposterior sizing in total knee arthroplasty[J].Clin Orthop Relat Res,2012,470(12):3560-3565.
[15]Akamatsu Y,Kobayashi H,Kusayama Y,et al.Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis:a comparison with radiograph and its predictive factors[J].Arch Orthop Trauma Surg,2016,136(9):1-6.
[16]Abdelaal A,Yamamoto N,Hayashi K,et al.Radiological assessment of the femoral bowing in Japanese population[J].SICOT J,2016,22(2):2.
[17]Kazemi SM,Shafaghi T,Minaei R,et al.The effect of sagittal femoral bowing on the femoral component position in total knee arthroplasty[J].Arch Bone Jt Surg,2017,5(4):250-254.
[18]Shawen SB,Belmont PJ Jr,Klemme WR,et al.Osteoporosis and anterior femoral notching in periprosthetic supracondylar femoral fractures:a biomechanical analysis[J].J Bone Joint Surg(Am),2003,85(1):115-121.
[19]Ma R,Ae T,Em K,et al.The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome[J].J Bone Joint Surg(Am),2005,87(11):2411-2414.
[20]孙云波,刘军,田峥巍,等.全膝关节置换股骨切迹发生因素分析及远期随访研[J].中国矫形外科杂志,2011,279(13):1073-1076.
[21]Li Y,Tian H,Geng X.Effect of the surgical time and coronalmechanical alignment after total knee arthroplasty using computer navigation system,traditionalor 3D printing patient-specific instruments[J].Zhonghua Yixue Zazhi,2018,98(27):2157-2161.
[22]Trudell MB.Anterior femoral curvature revisited:race assessment from the femur[J].J Forensic Sci,1999,44(4):700-707.
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