Abstract：Objective To investigate the application of measuring the femoral valgus angle and intramedullary rod entry point on 3D models and 2D images in total knee arthroplasty(TKA).Methods Imaging data from 105 patients who underwent lower limb computed tomography angiography(CTA) were gathered.This cohort comprised 65 males and 40 females，with ages ranging from 26 to 69 years，averaging(52.40±3.22)years.Among these patients，49 underwent procedures on their left knee，while 56 underwent procedures on their right knee.The CT scans of these 105 patients were then imported into Mimics software (version 19.0) for the purpose of creating 3D reconstructions of the femur.Utilizing the Fluoroscopy Simulation tool，2D femoral images were derived from the 3D models.Subsequently，the femoral valgus angle and intramedullary rod entry point were measured on both the 3D models and the 2D images.The collected data were then analyzed using the Shapiro-Wilk test for statistical significance.Results (1)There was no statistically significant difference observed in the femoral valgus angle measurements between 3D models and 2D images (P＞0.05).However，notable statistical differences were found in the measurements of the intramedullary rod entry point，Whiteside’s line，and the distance to the highest point of the intercondylar notch between 3D models and 2D images (P＜0.05).(2)Among the parameters measured on 3D models，significant statistical differences were evident in the femoral valgus angle，the position of the intramedullary rod entry point，and the distance to the highest point of the intercondylar notch between different genders (P＜0.05).Conversely，the distance between the intramedullary rod entry point and Whiteside’s line did not demonstrate any statistically significant difference (P＞0.05).(3)The correlation analysis between age and the femoral valgus angle revealed a 〖JP2〗positive correlation with a correlation coefficient of r＝0.54(P＜0.001).Conclusion The intramedullary rod entry point determined using Whiteside’s line and the highest point of the intercondylar notch on 2D images is not a dependable reference for TKA.Consequently，data pertaining to the intramedullary rod entry point obtained from X-rays cannot provide precise parameters for TKA.However，the outcomes of measuring the femoral valgus angle on 2D images possess significant reference value and demonstrate variations in accordance with age and gender.
［1］Kloppenburg M，Berenbaum F.Osteoarthritis year in review 2019：Epidemiology and therapy［J］.Osteoarthritis Cartilage，2020，28(3)：242-248.
［2］Picard F，Deakin A，Balasubramanian N，et al.Minimally invasive total knee replacement：Techniques and results［J］.Eur J Orthop Surg Traumatol，2018，28(5)：781-791.
［3］杜敏聪，李征，江云飞，等.国产机器人辅助全膝关节置换术的精准度和短期临床疗效［J］.实用骨科杂志，2023，29(6)：502-508.
［4］Wang JC，Piple AS，Hill WJ，et al.Computer-navigated and robotic-assisted total knee arthroplasty：Increasing in popularity without increasing complications［J］.J Arthroplasty，2022，37(12)：2358-2364.
［5］Zhang GH，Li K，Zhao B，et al.Clinical effects of robot-assisted total knee arthroplasty compared with traditional surgery：A meta-analysis［J］.Zhongguo Gushang，2019，32(9)：846-852.
［6］Luo T，Zhou YG，Sun JY.Application of individualized setting of femoral opening point and valgus angle in artificial total knee arthroplasty for patients with external femoral arch［J］.Zhongguo Gushang，2021，34(12)：1147-1152.
［7］Stotter C，Reiter E，Schretter W，et al.Influence of the femoral entry point for intramedullary alignment in total knee arthroplasty：A computer-aided design approach［J］.Jt Dis Relat Surg，2022，33(2)：294-302.
［8］虞丁柱.通过CT 3D重建对常用股骨髓内定位杆进针点位置的研究［D］.青岛：青岛大学，2021.
［9］Ma LY，Wei HY，Wan FY，et al.An innovative three-dimensional method for identifying a proper femoral intramedullary entry point in total knee arthroplasty［J］.Chin Med J (Engl)，2018，131(21)：2531-2536.
［10］区永亮.数字技术在国人膝置换术中精准股骨髓内定位的应用研究［D］.广州：南方医科大学，2022.
［11］Wangroongsub Y，Cherdtaweesup S.Proper entry point for femoral intramedullary guide in total knee arthroplasty［J］.J Med Assoc Thai，2009，92(Suppl 6)：S1-S5.
［12］Swanson KE，Stocks GW，Warren PD，et al.Does axial limb rotation affect the alignment measurements in deformed limbs?［J］.Clin Orthop Relat Res，2000(371)：246-252.
［13］Liu L，Lei K，Chen X，et al.Is valgus cut angle based on radiographic measurements in total knee arthroplasty really inaccurate?A comparison of two-and three-dimensional measurements［J］.J Knee Surg，2022，35(14)：1563-1570.
［14］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 arthroplasty planning［J］.Chin Med J (Engl)，2017，130(21)：2557-2562.
［15］Bae DK，Song SJ，Yoon KH，et al.Intraoperative assessment of resected condyle thickness in total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2012，20(10)：2039-2046.
［16］武建运.膝骨性关节炎下肢负重位等比例全长X线片测量与分析［D］.长春：吉林大学，2018.
［17］Liu T，Wang CY，Xiao JL，et al.Three-dimensional reconstruction method for measuring the knee valgus angle of the femur in northern Chinese adults［J］.J Zhejiang Univ Sci B，2014，15(8)：720-726.
［18］刘力铭.临床相关股骨解剖参数2D测量值与3D测量值对比研究［D］.重庆：中国人民解放军陆军军医大学，2023.
［19］Babazadeh S，Dowsey MM，Bingham RJ，et al.The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography［J］.Knee，2013，20(4)：242-249.
［20］管士坤，丁堃，刘宁.数字骨科技术在膝关节单髁置换术中的应用进展［J］.实用骨科杂志，2022，28(10)：930-934.
晋公网安备 14010702070875号