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MRI辅助下膝关节骨关节炎伴内翻畸形患者股骨远端3种旋转轴线与外科经股骨上髁轴的准确性比较

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Keywords: 膝关节,关节置换,股骨旋转,°,PCL,磁共振

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Abstract:

目的在磁共振(magneticresonanceimaging,MRI)上测量膝关节重度骨关节炎(osteoarthritis)伴内翻畸形患者股骨远端不同旋转轴线,评估各参照轴线相对于外科经股骨上髁轴(surgicaltransepicondylaraxis,STEA)的准确性。方法回顾性分析2013年6月至2014年1月在我中心明确诊断为膝关节重度骨关节炎伴内翻畸形患者(内翻≤15°)86例(86膝)的临床资料,其中男性34例,女性52例;年龄51~70(63.7±8.7)岁,由2位医师在MRI横断面图像上定位STEA、临床经股骨上髁轴(clinicaltransepicondylaraxis,CTEA)、后踝轴(posteriorcondylarline,PCL)外旋3°线(3°extorsionagainstPCL,3°PCL)、前后轴(anteriorposteriorline,APL)的垂线,测量各轴线相对于STEA偏差的角度,并用方差分析比较各角度接近STEA的精确性。结果3°PCL相对于STEA外旋(0.63°±1.82°)、CTEA相对于STEA外旋(3.78°±0.75°),APL垂线相对于STEA外旋(5.38°±3.17°),精确度:A角(3°PCL相对于STEA旋转的角度)>CSA(CTEA相对于STEA旋转的角度)>ASA(APL垂线相对于STEA旋转的角度),各角度两两比较差异具有统计学意义(P<0.01)。结论膝关节重度骨关节炎伴轻度内翻人群中,股骨远端截骨轴线除STEA外,3°PCL准确性最高;术中STEA定位困难时,参照3°PCL进行截骨可获得较好的股骨旋转准确度。

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