The sulcus line of the trochlear groove is more accurate than Whiteside's Line in determining femoral component rotation
The sulcus line of the trochlear groove is more accurate than Whiteside's Line in determining femoral component rotation
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DOI：
10.1007/s00167-014-3137-8
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发表时间：
2015-11-01
影响因子：
3.8
通讯作者：
Bartlett, John
中科院分区：
文献类型：
--
作者：
Talbot, Simon;Dimitriou, Pandelis;Bartlett, John
沟线 (SL) 是由沿滑车沟的多个点产生的三维曲线。怀特塞德线，也称为前后轴 (APA)，源自单个前点和后点。本文提出的两项研究的目的是 (1) 评估大型临床系列中 SL 的临床使用结果，(2) 在三维 CT 重建上测量 SL 和 APA，(3) 证明视差误差对 APA 使用的影响，以及 (4) 确定通过结合 SL 和后髁轴 (PCA) 得出的轴的准确性。在第一项研究中，我们 使用大型、单一外科医生系列的连续接受初次全膝关节置换术的患者来评估 SL。检查患者 (n = 200) 的术后 CT 扫描以确定股骨假体的最终旋转对准。在第二项研究中，对骨关节炎膝关节的一系列 3DCT 重建进行了测量（n = 44）。临床系列中股骨假体的平均位置为相对手术上髁轴外旋 0.6A 度，标准差为 2.9A 度（范围从 -7.2A 度到 6.7A 度）。在 3DCT 重建中，APA（88.2A 度 A A +/- A 4.2A 度）的方差显着高于 SL（90.3A 度 A A +/- A 2.7A 度）（F = 5.82 且 p = 0.017）。通过平均 SL 和 PCA+3A 度数得出的轴显着减少了异常值的数量（相对于 PCA，p = 0.03，相对于 SL，p = 0.007）和方差（相对于 SL，F = 6.15，p = 0.015）。 SL 的冠状对准相对于机械轴（0.4A 度 A A +/- A 3.8A 度）和远端髁表面（2.6A 度 A A +/- A 4.3A 度）变化很大。用于确定 SL 的多个点具有解剖学和几何学优势，因此，应将其视为 APA 的单独旋转标志。这些发现可以解释文献中记录的 APA 测量的高度变异性。将几何上正确的 SL 和 PCA 相结合可能会进一步提高精度。
The sulcus line (SL) is a three-dimensional curve produced from multiple points along the trochlear groove. Whiteside's Line, also known as the anteroposterior axis (APA), is derived from single anterior and posterior points. The purposes of the two studies presented in this paper are to (1) assess the results from the clinical use of the SL in a large clinical series, (2) measure the SL and the APA on three-dimensional CT reconstructions, (3) demonstrate the effect of parallax error on the use of the APA and (4) determine the accuracy of an axis derived by combining the SL and the posterior condylar axis (PCA).In the first study, we assessed the SL using a large, single surgeon series of consecutive patients undergoing primary total knee arthroplasties. The post-operative CT scans of patients (n = 200) were examined to determine the final rotational alignment of the femoral component. In the second study, measurements were taken in a series of 3DCT reconstructions of osteoarthritic knees (n = 44).The mean position of the femoral component in the clinical series was 0.6A degrees externally rotated to the surgical epicondylar axis, with a standard deviation of 2.9A degrees (ranges from -7.2A degrees to 6.7A degrees). On the 3DCT reconstructions, the APA (88.2A degrees A A +/- A 4.2A degrees) had significantly higher variance than the SL (90.3A degrees A A +/- A 2.7A degrees) (F = 5.82 and p = 0.017). An axis derived by averaging the SL and the PCA+3A degrees produced a significant decrease in both the number of outliers (p = 0.03 vs. PCA and p = 0.007 vs. SL) and the variance (F = 6.15 and p = 0.015 vs. SL). The coronal alignment of the SL varied widely relative to the mechanical axis (0.4A degrees A A +/- A 3.8A degrees) and the distal condylar surface (2.6A degrees A A +/- A 4.3A degrees).The multiple points used to determine the SL confer anatomical and geometrical advantages, and therefore, it should be considered a separate rotational landmark to the APA. These findings may explain the high degree of variability in the measurement of the APA which is documented in the literature. Combining a geometrically correct SL and the PCA is likely to further improve accuracy.