CAJ | 학술논문

目的测量股骨远端旋转力线相关参考轴的关系,为全膝关节置换术(TKA)股骨端假体旋转力线的定位提供理论依据.方法通过MIMICS软件观察75例健康成年人双侧股骨远端CT扫描轴位连续断层图片,应用三维坐标准确定位各解剖标志,选取股骨内上髁凹槽最明显处附近8张图片,分别找出股骨外科上髁轴与股骨后髁轴线(PCL)之间的夹角(股骨后髁角,PCA)、股骨解剖上髁轴与PCL之间的夹角(股骨髁扭转角, CTA)及前后轴线的垂线与PCL的夹角(APA);对股骨远端进行三维重建,使用各解剖标志坐标自动生成股骨远端旋转力线各参考轴的三维立体图像.在连续断层与三维重建图像上分别测量PCA、CTA和APA,同时比较三维图像上各角度不同性别、侧别之间的关系.结果连续断层图片上各角度测量结果:PCA为1.92°(—0.9°~4.2°)、APA为2.55°(0.2°~5.8°)、CTA为5.33°(2.1°~8.0°).三维重建图片上男、女各角度测量结果:PCA为3.54°±0.61°、3.61°±0.39°,APA为3.39°±0.42°、3.66°±0.53°,CTA为6.21°±0.65°、6.02°±0.43°.三维重建图像上不同性别、侧别间PCA、CTA与APA的差异无统计学意义(P>0.05).结论连续二维断层图片上股骨远端旋转力线的参考参数变化范围大,不利于旋转力线的定位;基于CT重建技术在三维图像上可以准确测量旋转力线相关的参考参数,有利于TKA术中重建股骨远端精确的旋转力线.
목적측량고골원단선전력선상관삼고축적관계,위전슬관절치환술(TKA)고골단가체선전력선적정위제공이론의거.방법통과MIMICS연건관찰75례건강성년인쌍측고골원단CT소묘축위련속단층도편,응용삼유좌표준학정위각해부표지,선취고골내상과요조최명현처부근8장도편,분별조출고골외과상과축여고골후과축선(PCL)지간적협각(고골후과각,PCA)、고골해부상과축여PCL지간적협각(고골과뉴전각, CTA)급전후축선적수선여PCL적협각(APA);대고골원단진행삼유중건,사용각해부표지좌표자동생성고골원단선전력선각삼고축적삼유입체도상.재련속단층여삼유중건도상상분별측량PCA、CTA화APA,동시비교삼유도상상각각도불동성별、측별지간적관계.결과련속단층도편상각각도측량결과:PCA위1.92°(—0.9°~4.2°)、APA위2.55°(0.2°~5.8°)、CTA위5.33°(2.1°~8.0°).삼유중건도편상남、녀각각도측량결과:PCA위3.54°±0.61°、3.61°±0.39°,APA위3.39°±0.42°、3.66°±0.53°,CTA위6.21°±0.65°、6.02°±0.43°.삼유중건도상상불동성별、측별간PCA、CTA여APA적차이무통계학의의(P>0.05).결론련속이유단층도편상고골원단선전력선적삼고삼수변화범위대,불리우선전력선적정위;기우CT중건기술재삼유도상상가이준학측량선전력선상관적삼고삼수,유리우TKA술중중건고골원단정학적선전력선.
Objective To investigate the relationship of the reference axes related to rotational alignment of distal femur, and to provide theoretical basis for the positioning of femoral prosthesis rotational alignment during total knee arthroplasty (TKA). Methods Seventy-five healthy adults were involved and the bilateral distal femurs were scanned by CT. Through MIMICS software, continuous section scanning images in axial view were observed, each anatomical landmark were positioned using 3D coordinate, 8 images around the image in which showed femoral epicondyle groove most obviously were selected, and the following angles were found: posterior condylar angle (PCA), which was formed by posterior condylar line (PCL) and surgical transepicondylar axis;condylar twist angle (CTA), which was formed by PCL and anatomical transepicondylar axis; the angle between the perpendicular line of anteroposterior axial line and PCL (APA). Then 3D reconstruction of distal femur based on continuous section images were performed, and 3D stereopictures for reference axes related to rotational alignment were generated automatically according to each anatomical landmark coordinate. PCA, APA, CTA in images of continuous section scanning as well as 3D reconstruction pictures were then measured, the differences of the angles between male and female, left side and right side were compared respectively in 3D reconstruction images. Results The angles in the continuous section scanning images were as follows: PCA was 1.92° (—0.9°-4.2°), APA was 2.55°(0.2°-5.8°), and CTA was 5.33°(2.1°-8.0°). The angles in 3D reconstruction images were as follows: PCA was 3.54 ° ± 0.61 ° in male, and 3.61 °± 0.39 ° in female, APA was 3.39 °± 0.42 ° in male and 3.66 °± 0.53 ° in female, CTA was 6.21 ° ± 0.65 ° in male and 6.02 °± 0.43 ° in female, where showed no statistically differences between male and female (P>0.05). Also, the differences of each angle were no statistical significance between left and right legs (P >0.05). Conclusions For the measurement of reference axes related to rotational alignment of distal femur, the method of measuring angles in continuous section scanning images is unfavorable to position the rotational alignment because the parameters range greatly. The 3D reconstruction technique can accurately measure reference axes based on CT scanning, which is helpful for reconstructing distal femoral rotational alignment during TKA procedure.