【作者】 王学明；

【导师】 左建林；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2019， 硕士

【摘要】 背景:由于人群预期寿命的延长,膝关节骨关节炎的(knee osteoarthritis,KOA)的发病率逐渐增加,对老年人生活质量造成极大影响。随着关节外科手术技术的发展,膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)对单侧间室骨关节炎有显著疗效,同时可保存另一侧间室的正常结构。UKA术中股骨和胫骨假体旋转对线是我们要考虑的重要问题,对于股骨假体外旋的参考,一般选择股骨外科上髁轴线,而对于胫骨假体旋转的解剖学参考目前尚未达成一致。目的:本研究通过对膝关节MRI上胫骨解剖标志的测量,为UKA术中胫骨假体旋转提供参考。方法:本次研究共纳入22例于我院接受膝关节单髁置换的患者,其中男性6例,女性16例;平均年龄为59.7岁(45-80岁),行膝关节伸直中立位MRI扫描。分别测量股骨外科上髁轴(SEA)与胫骨内侧髁间嵴(MIR)之间的角度、胫骨平台面髌腱内侧缘与内侧髁间结节连线的替代AP(s AP)线之间的角度和胫骨前后轴(AP)之间的角度。然后,当平行于MIR线、s AP线和AP线进行虚拟矢状截骨时,测量胫骨内侧截骨面的最大宽度和长度(m/l)比率。结果:MIR线相对于SEA外旋95.8°±3.5°(88.7°-102.6°),s AP线相对于SEA外旋90.6°±3.4°(83.4°-95.5°),胫骨AP线相对于SEA外旋90.3°±3.4°(83.0°-95.4°)。MIR相对于胫骨AP线外旋了大约5.8°(P<0.001)。胫骨AP线和s AP线相对于SEA的平均旋转角度没有差异(P=0.747)。平行于MIR进行的矢状截骨面m/l比率为0.50±0.023(0.44-0.55),平行于s AP线进行的矢状截骨面的m/l比率为0.53±0.025(0.46-0.58),平行于AP线进行的矢状截骨面的m/l比率为0.53±0.027(0.46-0.58)。平行于s AP线和AP线m/l比率更接近于假体的m/l比率。结论:获得胫骨前后方向在膝关节单髁置换和在全膝关节置换中同等重要,胫骨矢状截骨时参考MIR线有导致胫骨假体外旋的可能,s AP线几乎和AP线平行,理论上可以作为膝关节单髁置换中胫骨假体旋转定位参照轴线。更多还原

【Abstract】 Background: Due to the prolonged life expectancy of the population,the incidence of knee osteoarthritis(KOA)increased gradually,which has a great impact on the quality of life of the elderly.With the development of joint surgery techniques,unicompartmental knee arthroplasty(UKA)has a significant effect on unilateral compartmental osteoarthritis.The rotation of femoral and tibial component is an important problem to be considered during operation.For the reference of external rotation of femoral component,the surgical epicondylar axis is generally chosen,but the rotation of tibial component has not been agreedObjective: Through the measurement of the anatomical landmark of the tibia on the MRI of the knee joint,aiming to provide a reference for the rotation of the tibial component in the UKA.Methods:This study included 22 patients who underwent knee arthroplasty in our hospital,including 6 males and 16 females,with an average age of 59.7 years(45-80 years).MRI scan was performed in the medial position of knee extension.The angles between the surgical epicondylar axis(SEA)and the medial intercondylar ridge(MIR),the substitute AP(s AP)line connecting the medial border of the patellar tendon at the articular surface level and the medial tubercle,and the tibial anteroposterior(AP)were measured,respectively.Then,when the virtual sagittal osteotomy was performed parallel to the MIR line,the s AP line and the AP line,the maximum width and length(m/ l)ratio of the tibial cut surface was measured.Results: The MIR was 95.8°±3.5°(88.7°-102.6°)relative to the external rotation of SEA,the s AP line was 90.6° ± 3.4°(83.4°-95.5°)relative to the external rotation of SEA,the AP line was 90.3° ±3.4°(83.0°-95.4°)relative to the external rotation of SEA.MIR was externally rotated by approximately 5.8° relative to the AP line of the tibia(P < 0.001).There was no difference in the average rotation angle of the tibia AP line and the s AP line relative to the SEA(P=0.747).The sagittal osteotomy m/l ratio parallel to MIR was 0.50 ± 0.023(0.44-0.55),the m/l ratio of the sagittal osteotomy parallel to the s AP line was 0.53 ± 0.025(0.46-0.58),the m/l ratio of the sagittal osteotomy parallel to the AP line was 0.53±0.027(0.46-0.58).The m/l ratio parallel to the s AP line and the AP line is closer to the m/ l ratio of the components.Conclusion: Obtaining AP orientation of the tibia is equally important in total knee arthroplasty and UKA.In sagittal osteotomy of the tibia,the reference MIR line may lead to external rotation of the tibial components,and s AP line is almost parallel to the AP line.It can be used as a reference axis for rotation orientation of the tibial components in UKA.更多还原