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中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 222 -230. doi: 10.3877/cma.j.issn.2096-0263.2021.04.005

关节置换

外翻膝全膝关节置换术后膝-踝关节力线评估
桂斌捷1,(), 张金陵1, 荣根祥1, 唐智1, 钱军1   
  1. 1. 230022 合肥,安徽医科大学第一附属医院骨科
  • 收稿日期:2020-08-25 出版日期:2021-08-05
  • 通信作者: 桂斌捷
  • 基金资助:
    安徽省高校自然科学研究重大项目(KJ2020ZD23)

Radiographic evaluation of knee-ankle alignment after total knee arthroplasty for valgus knee osteoarthritis

Binjie Gui1,(), Jinling Zhang1, Genxian Rong1, Zhi Tang1, Jun Qian1   

  1. 1. Department of Orthopaedics, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2020-08-25 Published:2021-08-05
  • Corresponding author: Binjie Gui
引用本文:

桂斌捷, 张金陵, 荣根祥, 唐智, 钱军. 外翻膝全膝关节置换术后膝-踝关节力线评估[J/OL]. 中华老年骨科与康复电子杂志, 2021, 07(04): 222-230.

Binjie Gui, Jinling Zhang, Genxian Rong, Zhi Tang, Jun Qian. Radiographic evaluation of knee-ankle alignment after total knee arthroplasty for valgus knee osteoarthritis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(04): 222-230.

目的

本研究的目的是评估膝关节外翻畸形导致踝关节力线异常,以及膝、踝关节力线参数之间相关性,研究全膝关节置换术后膝-踝关节力线改变和参数之间相关性。

方法

本研究共包括44例全膝关节置换的外翻型膝关节骨性关节炎,站立位下肢全长前后位片测量膝关节力线参数:髋-膝-踝关节角(HKA)、股骨-胫骨角(TFA)、股骨外翻角(FVA)、股骨角(FA)、胫骨角(TA)、膝关节倾斜角(AK);和踝关节参数:胫骨远端关节面角(DTAA)、距骨倾斜角(TTA)、踝关节倾斜角(TAA)。采用双侧检验配对t检验比较膝关节、踝关节手术前、后参数和术后参数变化统计学差异。采用散点图和双侧检验Pearson相关性检验评估膝关节、踝关节参数手术前、后、及手术后参数变化的相关性。

结果

结果显示膝关节外翻畸形,踝关节出现代偿性内翻。TKA后随着膝关节力线的纠正,各参数显著改善,同时踝关节力学参数发生相一致的改善。踝关节的力线参数改善与膝关节力线参数改变存在中低度相关性(P<0.01)。

结论

踝关节力学参数与膝关节力学参数存在相关性,全膝关节置换在改变膝关节力线的同时,可以改善踝关节力线,故需要在TKA中尽可能获得3°以内外翻或内翻的膝关节力线,从而尽可能改善踝关节力线,保护踝关节,降低踝关节OA发生。

Objective

The aim of this retrospective research is to evaluate the changes in ankle alignment due to knee malalignment and relation with valgus knee osteoarthritis, further study the knee-ankle alignment after total knee arthroplasty(TKA).

Methods

This research consisted of 44 patients who had underwent primary TKA due to vaglus knee osteoarthroplasty(OA). The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The knee alignment was estimated according to the hip-knee-ankle angle(HKA), Tibiofemoral angle(TFA), Femoral valgus angle(FVA), Femoral angle(FA), Tibial angle(TA) and Tilt angle of the knee (TAK). The ankel alignment was estimated according to Distal tibial articlar angle(DTAA), Talar tilt angle(TTA) and Tilt angle of ankle(TAA). The patients were separated into two sex-based group. The correlation between the knee and ankle parameters were estimated by the two-tailed paried t-test and Pearson's correlation tests.

Results

The results showed that valgus knee deformity accompany with the compensatory varus ankle deformity. After TKA, with correclation of knee alignment, the parameters of knee were significantly improved, and the parameters of ankle were uniformly improved. There was correlation between changes of ankle alignment and that of knee alignment(P<0.01).

Conclusions

The primary TKA could correct the vaglus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and post-operativly. Both knee and ankle malalignment can be stimulateously corrected following TKA.

表1 病例资料一览表
图1~3 膝、踝关节角度参数测量示意图
表2 手术前后膝关节和踝关节力线变化一览表
表3 膝关节、踝关节测量参数相关系数r值一览表
表4 膝关节置换术后膝关节和踝关节参数变化值相关系数r一览表
图13~15 术后TTA和FVA变化相关性,分别为所用样板、男性样本和女性样本
图25 术后男性样TAA和TAK变化相关性
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