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膝关节股骨后髁偏心距的临床研究进展
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Abstract:
Bellmans于2002年首次提出股骨后髁偏心距(posterior condylar offset, PCO)这一概念，并认为其与膝关节置换术后膝关节屈曲度存在相关性。目前针对PCO的测量方法主要包括4种：标准X线侧位片测量法简便易行，但却忽视了股骨内外侧髁的不对称性及股骨后髁软骨厚度；CT和MRI测量法，经扫描患膝后，经软件处理重建三位模型，在模型上测量PCO，虽然其不受投射角度限制，但二者术后患膝会存在假体金属伪影的干扰；术前影像学结合术中软骨厚度测量法得到的数值最为精确，但其受术者主观性影响较强。在膝关节置换术中，PCO有着重要的临床意义。PCO可通过改变胫骨平台后缘与股骨后皮质的旋转半径，从而影响膝关节最大屈曲度；此外，PCO的改变还会影响膝关节屈曲间隙，从而影响膝关节稳定性；PCO的改变同样会影响膝关节正常的解剖学结构及生物力学结构，从而可能导致骨溶解及术后假体的松动。本文主要对近几年PCO的临床研究进展作以综述。
Bellmans first proposed the concept of posterior condylar offset (PCO) in 2002, and believed that it was related to the knee flexion after knee replacement. At present, there are mainly four methods for measuring PCO: the standard X-ray lateral film measurement method is simple and convenient, but it neglects the asymmetry of the medial and lateral femoral condyles and the thickness of the posterior femoral condyle cartilage; CT and MRI measurement methods: after scanning the affected knee, the three-dimensional model was reconstructed through software processing, and PCO was measured on the model. Although it was not limited by the projection angle, the affected knee would be interfered by the metal artifact of the prosthesis; the value obtained by preoperative im-aging combined with intraoperative cartilage thickness measurement is the most accurate, but it is strongly influenced by the subjectivity of the operator. PCO has important clinical significance in knee replacement. PCO can affect the maximum knee flexion by changing the radius of rotation of the posterior edge of the tibial plateau and the posterior cortex of the femur; in addition, the change of PCO will also affect the knee flexion space, thus affecting the stability of the knee joint; the change of PCO will also affect the normal anatomical structure and biomechanical structure of the knee joint, which may lead to osteolysis and postoperative prosthesis loosening. This article mainly re-views the clinical research progress of PCO in recent years.
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