A common reference frame for describing rotation of the distal femur A CT-BASED KINEMATIC STUDY USING CADAVERS
A common reference frame for describing rotation of the distal femur A CT-BASED KINEMATIC STUDY USING CADAVERS
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DOI：
10.1302/0301-620x.91b5.21827
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发表时间：
2009-05-01
影响因子：
--
通讯作者：
Bellemans, J.
中科院分区：
文献类型：
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作者：
Victor, J.;Van Doninck, D.;Bellemans, J.
在全膝关节置换术中，了解股骨远端的旋转对线是确保股骨部件正确放置的关键。已经描述了许多参考轴，但关于它们的值和相互角度关系仍然存在分歧。我们的目的是验证一个几何定义的参考轴，表面衍生轴可以在轴向平面进行比较。在将光学跟踪装置刚性固定到股骨和胫骨上后，共对12具尸体标本进行了CT检查。进行三维重建以确定解剖表面点和几何参考。用红外光学跟踪系统测量股骨和胫骨在完全伸展和屈曲90 °时的空间关系，将所描述的解剖点和几何参考点进行坐标变换，得到相应轴线在股骨轴平面上的投影。三维CT重建的观察者间和观察者内变异性显示，除观察者间误差为2的转子轴外，所有轴的角度误差范围为0.16至1.15。在膝关节完全伸展的情况下，连接股骨髁最佳匹配球体中心的股骨横轴几乎与胫骨横轴重合（平均差-0.8度，SD 2.05）。屈曲90 °时，股骨横轴与胫骨机械轴正交（平均差-0.77 °，SD 4.08）。在所有表面衍生轴中，手术经上髁轴在投影到股骨轴向平面后与股骨横轴的关系最密切（平均差0.21度，SD 1.77）。后髁线是最一致的轴（范围-2.96度至-0.28度，SD 0.77），而股骨髁前后轴是最不一致的轴（范围-10.62度至+11.67度，SD 6.12）。后髁线和股骨髁前后轴的方向（p = 0.001）均显示出内旋和外翻冠状面对线的趋势。
The understanding of rotational alignment of the distal femur is essential in total knee replacement to ensure that there is correct placement of the femoral component. Many reference axes have been described, but there is still disagreement about their value and mutual angular relationship. Our aim was to validate a geometrically-defined reference axis against which the surface-derived axes could be compared in the axial plane. A total of 12 cadaver specimens underwent CT after rigid fixation of optical tracking devices to the femur and the tibia. Three-dimensional reconstructions were made to determine the anatomical surface points and geometrical references. The spatial relationships between the femur and tibia in full extension and in 90 of flexion were examined by an optical infrared tracking system.After co-ordinate transformation of the described anatomical points and geometrical references, the projection of the relevant axes in the axial plane of the femur were mathematically achieved. Inter- and intra-observer variability in the three-dimensional CT reconstructions revealed angular errors ranging from 0.16 to 1.15 for all axes except for the trochlear axis which had an interobserver error of 2. With the knees in full extension, the femoral transverse axis, connecting the centres of the best matching spheres of the femoral condyles, almost coincided with the tibial transverse axis (mean difference -0.8 degrees, SD 2.05). At 90 of flexion, this femoral transverse axis was orthogonal to the tibial mechanical axis (mean difference -0.77 degrees, SD 4.08). Of all the surface-derived axes, the surgical transepicondylar axis had the closest relationship to the femoral transverse axis after projection on to the axial plane of the femur (mean difference 0.21 degrees, SD 1.77). The posterior condylar line was the most consistent axis (range -2.96 degrees to -0.28 degrees, SD 0.77) and the trochlear anteroposterior axis the least consistent axis (range -10.62 degrees to +11.67 degrees, SD 6.12). The orientation of both the posterior condylar line and the trochlear anteroposterior axis (p = 0.001) showed a trend towards internal rotation with valgus coronal alignment.