本文選題：全膝置換術(shù) + 應(yīng)用解剖��； 參考：《河北醫(yī)科大學(xué)》2006年博士論文

【摘要】： 1.脛骨近端、股骨遠(yuǎn)端和髕骨旋轉(zhuǎn)關(guān)系的臨床解剖學(xué)研究 目的:通過對膝關(guān)節(jié)軸位MRI片上的測量,1)量化正常膝關(guān)節(jié)伸直時股骨上髁橫軸(femoral epicondylar axis, FE)、股骨髁后緣軸線(posterior femoral axis, PF)、脛骨髁后緣軸線(posterior tibial axis, PT)、髕骨軸(patellar axis, PAT)之間的關(guān)系。2)確定在脛骨假體旋轉(zhuǎn)對線中起定位作用的脛骨墊短軸與髕韌帶(patellar ligament, PL)相交的位置。 材料與方法:于MRI工作站的計算機(jī)平臺上,在膝關(guān)節(jié)軸位MRI片上建立以下軸線:股骨上髁橫軸(FE)、股骨髁后緣軸線(PF)、脛骨髁后緣軸線(PT)、髕骨橫軸(PAT)、髕韌帶軸(PL)。脛骨髁后緣軸線(PT)由脛骨平臺后方內(nèi)外側(cè)骨皮質(zhì)表面的連線形成,于脛骨平臺關(guān)節(jié)軟骨以遠(yuǎn)8mm的層面上獲得。在同一層面建立髕韌帶橫軸(PL),它是由髕韌帶內(nèi)外側(cè)緣連線形成。在顯示股骨髁面積最大的層面上建立股骨上髁橫軸(FE),它是通過股骨內(nèi)、外上髁中心的連線。在同一層面可獲得股骨髁后緣軸線(PF),它是由股骨內(nèi)、外上髁后方的骨皮質(zhì)表面的連線形成。髕骨橫軸(PAT)是在髕骨長軸方向上,1/2髕骨的位置,由髕骨內(nèi)、外側(cè)透明軟骨邊緣的連線形成。測量上述四軸(PAT、FE、PF和PT)與髕韌帶橫軸(PL)間的夾角及相互間的夾角,用直線回歸評定四軸之間的相關(guān)程度,并計算相關(guān)系數(shù)r和確定系數(shù)R2。 為了確定TKA術(shù)中脛骨假體旋轉(zhuǎn)定位的合適位置,首先拍攝Howmedica公司的假體脛骨墊模板(該假體為對稱型設(shè)計,脛骨模板有6個型號),制成模板圖片后,在工作站上成比例縮放和轉(zhuǎn)動,使其長軸沿FE軸和PT軸分別安放,模板短軸(平分長軸寬度的垂線)前方與髕韌帶各區(qū)相交點的分布數(shù)據(jù)可用作評價脛骨假體相對髕韌帶旋轉(zhuǎn)的量化指標(biāo)。記錄模板短軸前方與髕韌帶的交點位置,用配對t檢驗比較交點位置的差異。 結(jié)果:1)旋轉(zhuǎn)軸間的相關(guān)性:FE軸和PAT軸明顯相關(guān)(r2=0.70),
[Abstract]:1. Clinical anatomic study of the relationship between the proximal tibia, distal femur and patella rotation Objective: to quantify the relationship between femoral epicondylar axis, FEA, posterior femoral axis, posterior tibial axis of tibial condyle, patellar axis, and patellar axis of patellar axis during normal knee extension by measuring the axial position of knee joint on MRI film. The position of the intersection of the short axis of the tibial pad and patellar ligaments of patellar ligaments (PLs) in the rotation of the tibial prosthesis is determined. Materials and methods: on the computer platform of MRI workstation, the following axes were established on the knee joint axial MRI: femur epicondyle axis, femoral condyle posterior edge axis, tibial condyle posterior edge axis, patellar transverse axis, patellar ligament axis. The posterior edge axis of tibial condyle (PTT) was formed from the line of posterior and lateral cortical surface of tibial plateau and was obtained from the articular cartilage of tibial plateau on a far 8mm level. The transverse axis of patellar ligament was established on the same plane, which was formed by the line of inner and outer edge of patellar ligament. The transverse axis of the femoral epicondyle was established on the plane showing the largest area of the femoral condyle, which was connected through the center of the inner and outer epicondyle of the femur. The posterior edge axis of the femoral condyle can be obtained on the same plane, which is formed by the line of the cortical surface inside the femur and behind the external epicondyle. Patellar transverse axis (Pat) is a 1 / 2 position of patella in the long axis of patella, which is formed by the line of inner and lateral hyaline cartilage edge of patella. The angle and the angle between the four axes (FEPF and PTT) and the transverse PLs of the patellar ligament were measured. The correlation degree between the four axes was evaluated by linear regression, and the correlation coefficient r and the definite coefficient R2 were calculated. In order to determine the proper position of rotation positioning of tibial prosthesis during TKA, Howmedica's tibial pad template was first photographed. Scaled and rotated on the workstation in proportion to place the long axis along the FE axis and the PT axis, The distribution data of the intersecting points in front of the template short axis (vertical line with the width of the long axis) can be used as a quantitative index to evaluate the rotation of the tibial prosthesis relative to the patellar ligament. The position of the junction between the short axis of the template and the patellar ligament was recorded, and the difference of the position of the junction was compared by paired t test. Results: 1) the correlation between the rotation axis and the PAT axis is significantly related to the ratio FE axis to the PAT axis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2006
【分類號】：R684;R322

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