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。

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关键词 ： CT三维重建, 股骨远段, 前偏角, 全膝关节置换术

Abstract：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 3D images 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.

Key words： CT three dimensional reconstruction distal femoral sagittal anterior angle total knee arthroplasty

基金资助:陆军军医大学第二附属医院临床科研基金(编号2016YLC21)

通讯作者: 王敏

作者简介: 柯松(1991－ )，男，医师，中国人民解放军陆军军医大学第二附属医院骨科，400037。

引用本文:

柯松，王敏 *，徐源，宋鑫，吕明锐，刘娇. 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[J]. 实用骨科杂志, 2019, 25(6): 523-527.
Ke Song，Wang Min *，Xu Yuan，et al. A Preliminary Study of DFSAA in the Knee Osteoarthritis Patients Based on CT-three Dimensional Reconstruction-measurement. sygkzz, 2019, 25(6): 523-527.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I6/523

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