髋臼后柱骨折经皮逆行拉力螺钉固定的三维重建模型研究

目的 为髋臼后柱骨折经皮逆行拉力螺钉固定提供应用解剖学基础. 方法 收集60个正常成人骨盆的螺旋CT扫描数据,重建骨盆三维模型.模拟逆行拉力螺钉固定,在髋臼后柱置入虚拟三维圆柱体.计算其最大直径、长度、置入角度以及置入点(A)到坐骨结节远端(B)的距离.同时在相同的三维重建骨盆模型上,垂直髋臼内侧面对后柱进行重切,每间隔1 cm取一个截骨面,测量每个截骨面的内外径和上下径. 结果 男性半骨盆58个,女性半骨盆62个.虚拟三维圆柱体的平均最大直径为(13.16±1.45)mm,虚拟三维圆柱体与水平面、冠状面和矢状面的夹角分别为72.02°±6.05°、14.71°±6.98°和8.61°±3.96°,置入点位于坐骨结节内外侧缘的中线上,AB间距离为(15.18±1.97)mm.平均最小内外径和上下径分别为20.11 mm、19.19 mm,明显大于虚拟三维圆柱体的平均最大直径.虚拟三维圆柱体的直径、长度、与矢状面的夹角在男女之间的差异有统计学意义(P＜0.001). 结论 髋臼后柱可容纳7.3 mm的拉力螺钉,但男女的进针角度不同.螺钉的直径不能仅仅靠截骨面的直径确定.     

前交叉韧带重建中两种建立股骨隧道方法的比较

[目的]对关节镜下重建前交叉韧带(ACL)手术中,经胫骨隧道与髌下前内侧入路建立股骨隧道的长度、角度进行比较.[方法]在140例ACL移植重建患者中,70例采用经胫骨隧道、70例经前内入路建立股骨隧道,术中记录股骨隧道长度,术后行膝关节前后位及侧位X线检查,测量股骨隧道在冠状面与内外髁连线及矢状面与股骨干轴线夹角,并使用t检验进行统计分析.[结果]经胫骨隧道组及经前内人路组股骨隧道长度分别为(50.67±5.00) mm、(37.97±4.45) mm,后者股骨隧道长度短于前者,差异非常显著(P＜0.01)；冠状面股骨隧道角度两者分别为68.20°±6.92°；矢状面为45.45°±7.47°、32.81°±9.45°,无论在冠状面及矢状面,前内入路组股骨隧道角度均小于胫骨隧道组,差异非常显著(P＜0.01).[结论]在关节镜下ACL移植重建手术中,采用前内入路制备的股骨隧道,长度短、角度小.它可以减小“雨刮效应”和“蹦极效应”发生的可能,最终获得更好的临床效果.     

骨盆径线CT测量方法

目的 探讨CT骨盆径线的测量方法及其临床意义.方法 前瞻性地对45例直肠癌病例进行术前盆腔CT增强扫描和图像三维重建,并测量8个骨盆径线参数:骨盆人口前后径、中骨盆前后径、骨盆出口前后径、耻骨联合上下径、坐骨棘间径、坐骨结节问径、骶尾径、骶尾曲径.结果 代表骨盆宽度的骨盆入口前后径、坐骨棘间径、坐骨结节间径女性显著宽于男性(P＜0.05);而代表骨盆深度的耻骨联合上下径、骶尾径、骶尾曲径男性均显著大于女性(P＜0.05).结论 CT测量骨盆径线可判断骨盆的宽窄与深浅,能基本反映中国男性和女性骨盆的特征.     

骨盆径线CT测量方法

目的 探讨CT骨盆径线的测量方法及其临床意义.方法 前瞻性地对45例直肠癌病例进行术前盆腔CT增强扫描和图像三维重建,并测量8个骨盆径线参数：骨盆人口前后径、中骨盆前后径、骨盆出口前后径、耻骨联合上下径、坐骨棘间径、坐骨结节问径、骶尾径、骶尾曲径.结果 代表骨盆宽度的骨盆入口前后径、坐骨棘间径、坐骨结节间径女性显著宽于男性（P＜0.05）;而代表骨盆深度的耻骨联合上下径、骶尾径、骶尾曲径男性均显著大于女性（P＜0.05）.结论 CT测量骨盆径线可判断骨盆的宽窄与深浅,能基本反映中国男性和女性骨盆的特征.     

隐匿性骨盆后环损伤的影像学表现及临床意义

目的：探讨临床容易忽视的隐匿性骨盆后环损伤的影像学表现及其临床意义。方法：调阅2003年1月至2008年1月我院影像学资料完整的178例骨盆创伤病历，发现21例骨盆CR正位片显示后环正常或疑似损伤，调阅其骨盆螺旋CT发现其中17例均有骨盆后环损伤，其中男11例，女6例；年龄19-71岁，平均34．7岁。螺旋CT检查方法：平描层厚3mm，同时做冠状面、矢状面及骶骨曲面重建。对CR片及CT图像进行横向对照，结合患者临床情况进行分析研究。结果：17例中CR正位片显示骨盆前环耻、坐骨支骨折或耻骨联合损伤。CT多维重建显示后环骶骨骨折DenisⅠ型5例、Ⅱ型5例、Ⅲ型2例，骶髂关节分离移位1例，骶骨合并髂骨后部骨折4例。按受伤机制分析，17例漏诊患者中15例属于侧方挤压暴力导致的内旋损伤，2例属于前后挤压暴力导致的外旋损伤，按Young—Burgess分型：LCⅠ型11例、Ⅱ型4例和APCⅠ型2例；按Tlie和AO分型均为B型旋转不稳定。资料CR正位片骨盆后环骨折确诊率为89％。螺旋CT横断面、冠状面、矢状面和骶骨曲面4个面的重建同时应用，对微细骨折检出率为100％。结论：螺旋CT4个面的重建同时应用是确诊骨盆后环骨折的“金标准”，为更精确的诊断提供科学依据，降低并发症，减少漏诊率。     

Crowe Ⅳ型DDH脊柱-骨盆-下肢矢状面平衡状态异常及其临床意义

[目的]通过比较Crowe IV型髋关节发育不良患者(developmental dysplasia of hip,DDH)与正常人和原发性髋骨性关节炎患者(hip osteoarthritis,HOA)的矢状面相关参数,探讨DDH患者矢状面形态异常及其临床意义。[方法]研究收集正常人40例、HOA患者30例和双侧Crowe IV型DDH患者16例的站立位全脊柱侧位X线片并测量下列参数:(1)骨盆矢状面参数:骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骶骨骨盆角(sacrum pubic incidence,SPI)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);(2)脊柱矢状面参数:脊柱前倾角(spinal tilt,ST)、腰椎前凸角(lumbar lordosis,LL);(3)下肢矢状面参数:股骨倾斜角(femoral inclination,FI)。采用ANOVA检验分析各组间各矢状面参数间的差异性,同时进行各组间各个参数的可信度比较分析。[结果]三组间年龄、性别分布差异无统计学意义。DDH组的PI可信度(a=0.008)较正常对照组(a=0.350)及HOA组(a=0.276)低。DDH组SS(45.6±12.09)、PT(16.7±8.81)、PI(55.3±16.63)、PFA(12.7±15.15)、SPI(76.4±10.87)、FI(14.3±7.12)均较HOA组增大,差异有统计学意义(P<0.05);LL(37.3±15.87)、ST(87.8±5.43)均与HOA组相近,差异无统计学意义,但与正常对照组相比差异均有统计学意义(P<0.05)。[结论]DDH患者较HOA患者骨盆更加前倾,导致其脊柱前倾,髋、膝关节屈曲。DDH患者的这些矢状面形态在行全髋关节置换术设计时需要加以考虑。     

经胫骨隧道与前内侧入路建立前交叉韧带股骨隧道的比较研究

目的 比较关节镜下前交叉韧带(ACL)重建术中经胫骨隧道与髌下前内侧入路建立股骨隧道的长度和角度。 方法回顾性分析2000年11月至2009年11月收治的102例ACL重建手术患者资料,其中50例采用经胫骨隧道建立股骨隧道（经胫骨隧道组）：男39例,女11例;年龄15～49岁,平均（27.9±7.6）岁。52例采用经前内侧入路建立股骨隧道（前内侧入路组）：男33例,女19例;年龄15～56岁,平均(30.5±10.7)岁。术中记录股骨隧道长度,术后行膝关节前后位及侧位X线片检查,测量股骨隧道在冠状面与内、外髁连线及矢状面与股骨干轴线的夹角,并进行统计学分析。 结果 经胫骨隧道组股骨隧道的平均长度[（50.9±5.0）mm]长于前内侧入路组[(37.8±4. 7)mm],差异有统计学意义(t=15.083,P=0. 000);经胫骨隧道组冠状面股骨隧道角度(68.6°±7.0°)、矢状面股骨隧道角度(45.1°±8.1°)均大于前内侧入路组(49.8°±7.7°)、33.7°±9.7°),差异均有统计学意义(t=12. 874,P=0. 000;t =5. 877,P=0. 000)。 结论关节镜下ACL重建术中,采用前内侧入路制备的股骨隧道长度短、角度小。     

膝关节骨关节炎患者脊柱-骨盆-下肢矢状面形态变化的初步研究

[目的]通过比较膝关节骨性关节炎(knee osteoarthritis,KOA)患者与正常人的矢状面相关参数,探讨KOA患者矢状面形态异常及其临床意义。[方法]研究收集正常人64例和KOA患者62例的站立位全脊柱侧位X线片并测量下列参数:(1)脊柱矢状面参数:脊柱骶骨角(spinal-sacral angle,SSA)、脊柱前倾角(spinal tilt,ST)、腰椎前凸角(lumbar lordosis,LL);(2)骨盆及相关下肢矢状面参数:骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);股骨倾斜角(femoral inclination,FI)。采用独立样本t检验分析组间各矢状面参数间的差异性,同时应用Pearson相关性分析KOA组各个参数相关性。[结果]两组间年龄、性别分布差异无统计学意义。KOA组FI(11.0±5.2)较正常对照组增大,但SFA(43.3±11.8)和PFA(2.0±9.2)值较正常对照组(SFA:52.0±8.5;PFA:8.8±7.9)减小,且差异均有统计学意义(P<0.05);此外KOA组ST(88.6±4.2)值较正常对照组(93.0±3.4)减小,且差异有统计学意义(P<0.05);而SS、PT和PI值与正常对照组相近,且差异无统计学意义(P>0.05)。KOA组SFA与PFA存在明显正相关(r=0.494),而与FI则存在明显负相关(r=-0.668);PFA与FI存在明显负相关(r=-0.586)。[结论]KOA患者膝关节明显屈曲,导致其脊柱和骨盆前倾。KOA患者的这些矢状面形态在行全膝关节置换术设计时需要加以考虑。     

骨盆韧带损伤对骶髂关节稳定性影响的生物力学研究

目的 探讨骨盆韧带损伤对骶髂关节稳定性的影响,为骨盆骨折的临床治疗提供理论依据. 方法取骨盆标本10具,完整保留关节及韧带结构,左侧组逐级离断耻骨联合、骶棘韧带、骶结节韧带、骶髂前韧带及骶髂前关节囊、骶髂骨间韧带,右侧组逐级离断耻骨联合、骶髂后长、后短韧带、髂腰韧带、骶髂骨间韧带,模拟人体单足站立位,力学机上给予轴向加载,测量并记录骶骨相对于髂骨的垂直位移及矢状面骶骨旋转角度(角移位). 结果左侧力学试验中,仅切断耻骨联合周围韧带、骶结节韧带,骶骨垂直位移、骶骨角位移,差异无统计学意义(P＞0.05).逐步切断骶髂前韧带、骶髂骨间韧带,骶骨的垂直位移数值由完整骨盆测量的(4.144±0.538)mm增至(5.853±0.368)mm;骶骨的旋转角度由骨盆完整时的0.226°±0.061°增至0.616°±0.086°,差异有统计学意义(P＜0.05).右侧力学试验中,逐次切断骶髂关节后部韧带,骶骨的垂直位移数值由完整骨盆测量的(3.610±0.696)mm增至(6.825±0.565)mm;骶骨的旋转角度由骨盆完整时的0.271°±0.094°增至0.746°±0.192°,差异有统计学意义(P＜0.05).结论 耻骨联合及其周围韧带的损伤对骶髂关节的稳定性无显著性影响;骶结节韧带、骶棘韧带对限制骶骨的角位移有很大作用;骨间韧带对骶髂关节稳定性的作用较大;骶髂后韧带与骨间韧带共同组成了骶髂关节后部韧带复合体,是骶髂关节周围韧带中的重要部分.     

前交叉韧带解剖重建股骨隧道的应用解剖学研究

目的:测量膝关节前交叉韧带解剖重建股骨隧道的解剖学数据,为临床前交叉韧带解剖重建提供解剖学基础。方法:采用30例成人尸体膝部标本。屈膝120°关节镜下经前内辅助入路(AMP)解剖重建前交叉韧带股骨隧道,并用克氏针标记。去除标本的软组织,正中劈开股骨髁。测量股骨隧道长度;测量隧道内口至股骨后髁皮质边缘的距离与股骨髁间窝顶的垂直距离,记录隧道内口分位点位于髁间窝的钟点位置;测量隧道外口与股骨外髁的相对位置。结果:股骨隧道长度平均(36.35±3.14)mm(30.65~42.35 mm);隧道内口至股骨后髁皮质边缘的距离(17.84±3.35)mm(14.02~23.49 mm),至股骨髁间窝顶的垂直距离(14.05±2.32)mm(9.17~20.08 mm)。根据表盘法,隧道内口位于左膝02∶30±00∶10(01∶50~02∶50),右膝09∶30±0∶15(08∶30~10∶40);股骨隧道外口位于股骨外上髁近端(3.16±2.51)mm(1.61~6.30 mm),后方(4.25±2.16)mm(1.73~8.52 mm)。结论:本研究揭示了前交叉韧带解剖重建股骨隧道的解剖学特点,为临床应用提供了解剖学基础。     

Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity

Tibial condylar valgus osteotomy (TCVO) is an intra-articular proximal tibial osteotomy developed in 1989 and has since been used for the treatment of knee osteoarthritis (OA) associated with genu varum. This article describes the surgical technique and clinical results of TCVO. TCVO can be used for all grades of varus knee OA in patients of any age. he preoperative range of movement should be at least 90°. Preoperative screening showed varus-valgus instability due to an intra-articular deformity of the proximal tibia. Using intraoperative image intensification, a sagittally oriented “L”-shaped osteotomy is made from the medial to the tibial tuberosity to the center of the tibial plateau between the medial and lateral tibial spines. The separation of the osteotomy using the lamina spreader is gradually increased using an image intensifier guidance until the articular surface of the lateral tibial plateau comes in contact with the articular surface of the lateral femoral condyle. Adequate correction is indicated by parallelism of the lateral tibial plateau and a line tangential to the distal convexity of the lateral femoral condyle on an anteroposterior (AP) image and the elimination of the valgus instability with the knee in extended position. A “T”-plate (locking or non-locking plate or circular external fixator) is used to fix the osteotomy in the corrected position. Synthetic or autologous bone grafts can be used. We used the Japanese Orthopaedic Association score to evaluate the patient's function and also measured the %MAD, medial plateau opening angle, medial plateau angle, and lateral plateau opening angle on an AP view of the long length roentgenogram of the lower limb (standing position). The JOA score, radiologically measured values, and instability of the knee joint remarkably improved.     

双束重建前十字韧带骨道位置的临床研究

目的 研究双束重建前十字韧带患者术后骨道位置与临床效果的关系,初步探讨双束重建前十字韧带的定位评价.方法 随访研究2005年5至12月33例自体胭绳肌腱双束重建前十字韧带的患者,通过X线片测量其骨道位置.术后29例获14～22个月(平均18个月)随访,进行膝关节功能评分、KT-2000及Biodex肌力测试评价.结果 患者术后IKDC、Lysholm和Tegner评分及KT-2000结果均较术前显著改善(P＜0.01).前内束股骨骨道位于Blumensaat线水平的股骨外髁长度的29.68%±5.25%,高度的16.93%±5.73%.后外束股骨骨道位于Blumensaat线水平的股骨外髁长度的30.33%±9.44%,高度的31.24%±6.87%.前内束和后外束胫骨骨道分别位于胫骨平台长度的32.92%±5.37%和46.33%±7.74%.前内束股骨骨道前后位置与KT-2000 30°前后稳定性呈负相关(P＜0.05),即前内骨道越偏后30°稳定性越好.前内束股骨骨道相对外髁高低程度与患肢术后120°角速度下屈肌力矩呈正相关.后外束股骨骨道前后位置与60°角速度下屈肌力矩呈正相关,后外束胫骨骨道前后位置与120°角速度下屈肌力矩呈负相关.骨道位置与各功能评分均未表现出相关性.结论 双束重建前十字韧带可取得很好的临床效果.X线测量可以较客观、准确地反映骨道的定位情况并分析临床效果.     

前交叉韧带原位双束重建技术的临床研究

目的探讨关节镜下个性化原位解剖重建前交叉韧带（ACL）的技术与结果。方法该技术包括3部分内容,首先在术前进行膝关节三维CT与MRI扫描了解患者韧带足迹与排列特点,其次在术中对髁问窝和ACL在股骨与胫骨的足迹进行测量,以明确可以进行双束重建。最后,根据患者的体质情况进行个性化康复训练。手术前后采用KT2000、Lysholm评分、IKDC评分、拉赫曼与轴移试验进行手术效果评估。SPSS15．0统计软件进行统计分析。结果选择82例患者,男52例,女30例,评均年龄25．2岁。根据术前CT与MRI评估发现,股骨外侧髁3种形态：四边形、中间形、三角形3种,其中四边形髁最适合进行双束重建,三角形髁需要术中仔细测量;股骨与胫骨的ACL足迹均有2种排列：直行与斜行,术中可据此进行骨道钻制。本组术中将ACL足迹长度大于14mm,且髁间窝宽度大于12mm的患者入选进行双束重建。手术前后,ACL足迹测量结果完全相符者65例,髁间窝宽度相符者71例。82例均进行个性化双束重建。术后平均随访时间15个月。术后三维CT显示骨道与术前设计相符,Lysholm评分由（49．3±9．2）分到（93．7±8．0）分,IKDC正常者77例,占94％。77例显示前后与旋转稳定均良好,4例双侧KT200检查显示3～4rnm前向松弛,但轴移阴性。1例失败需进行翻修。所有病例均对疗效满意。结论术前对股骨外髁形态、ACL股骨与胫骨足迹特点的判断对手术的设计至关重要,但手术中对髁间窝、ACL股骨与胫骨足迹的测量更具决定意义。采用个性化解剖位双束重建能较好地恢复患者膝关节稳定性。     

Influence of the position of the fibular head after implantation of a total knee prosthesis on femorotibial rotation

A gold standard for the correct rotation of the tibial component has not been established in total knee arthroplasty (TKA). The target parameter of correct rotation is the facilitation of femorotibial rotation over the entire range of motion with no implant overhang. Although the origin of the lateral collateral ligament is a recognized landmark for determining the rotation of the femoral component (epicondylar axis), the attachment of the lateral collateral ligament has not been taken into consideration for adjusting tibial rotation until now. The objective of the current investigation was to examine whether the position of the fibular head, as the attachment of the lateral collateral ligament, influences femorotibial rotation. Seventy patients who underwent TKA were enrolled in this retrospective study. Computed tomography (CT) of the operated knee was performed 6 months postoperatively in all cases and the position of the lateral facet of the fibular head and the tibial tuberosity, and the geometric center of the tibia and the femoral epicondyles were determined. The angle between the lateral facet of the fibular head, the geometric center of the tibia, and the tibial tuberosity was 45.7°±6.9°. The angle between the surgical epicondylar axis and the line from tibial tuberosity to tibial center was 69°±8.3°. This close correlation (R=.73; P<.001) shows that the position of the fibular head determines femorotibial rotation. The fibular head may become a helpful landmark for establishing the rotation of the tibial component; it could be useful in interpretation of postoperative CT scans in knees suspected of tibial malrotation.     

经坐骨结节至髋臼后柱置钉安全区域的CT测量研究

目的探讨利用CT测量经坐骨结节至髋臼后柱置钉的安全范围。方法收集60例正常成人骨盆的螺旋CT扫描数据,在扫描结果中包含股骨头最大界面的扫描平面,进行二维及三维重建,然后进行有效切割,获得内平面、外平面及后平面,分别测量经坐骨结节至三个平面的最大角度（α、β、γ）,测量获得髋臼后柱三角形内切圆面积及直径。结果坐骨结节至内平面的最大角度α约8．1°,坐骨结节至外平面的最大角度β约23．5°,坐骨结节至后平面的最大角度1约32．2°,髋臼1／2高度处后柱骨质最狭小（内切圆直径最小）,是判断置钉安全性的关键位置。结论经坐骨结节至髋臼后柱置钉的安全范围较小,有必要在置钉时精确量化与精确操作,严格按照个体化进行置钉。     

A “Two‐incision” Approach for En Bloc Resection of Periacetabular Tumors with Illustrations from a Cadaver

A “two‐incision” approach for en bloc resection of periacetabular tumors and prosthesis reconstruction is described. The first incision begins in the middle of the iliac crest, continues over the inguinal ligament, extends to the symphysis pubis and then turns down to ischial tuberosity. The muscles attached to the iliac crest are only separated from its internal side. All the attachments of the abductor muscles to the iliac crest are left intact. The second incision runs from the sacroiliac joint to the greater trochanter and is curved in shape, providing external exposure of the sciatic notch and ischial tuberosity. Communication between the two approaches is possible inside and outside under the abductor muscles or through the sciatic notch. En bloc resection of the tumor is performed by cutting the pubic symphysis and iliac as planned preoperatively. The iliac osteotomy is performed by using a Gigli saw that has been led through the sciatic notch and under the abductor muscles. This “two‐incision” approach not only provides enough exposure to perform en bloc resection of periacetabular tumors, but also protects the continuity of the abductor muscles between the pelvis and greater trochanter, thus preventing prosthesis dislocation.     

自体骨修复初次全膝关节置换术中胫骨骨缺损的临床研究

目的为了探讨初次全膝关节置换术中自体骨修复胫骨平台骨缺损患者植骨处的骨密度变化及骨愈合情况,对自体骨修复胫骨平台骨缺损患者的随访探讨。方法收集2008年6月至2010年3月,在15例（16膝）初次全膝关节置换术中,采用自体骨移植的方法修复胫骨平台骨缺损的患者。对照组收集同期的14例（16膝）无骨缺损患者。应用X线拍片及双能X线骨密度仪（DEXA）观察术后6个月、12个月时胫骨假体下骨密度。分为3个兴趣区（ROI）,对各个区内平均骨密度变化进行观察和分析。结果术后6个月时胫骨平台骨缺损处ROI的骨密度：（0.967±0.320）g/cm2,对照组ROI的骨密度：（0.946±0.263）g/cm2;术后12个月时胫骨平台骨缺损处ROI的骨密度：（0.808±0.258）g/cm2,对照组ROI的骨密度：（0.806±0.262）g/cm2。术后12个月时胫骨平台骨缺损植骨处平均骨密度较6个月时均数略有下降,但无统计学差异（P〉0.05）;术后6个月与12个月时胫骨平台骨缺损自体骨植骨处平均骨密度较无骨缺损患者ROI的骨密度无显著性差异（P〉0.05）。结论自体骨修复胫骨平台骨缺损的全膝关节置换术后患者植骨处骨密度较无骨缺损患者的骨密度无明显变化,骨愈合情况良好。     

中原地区未婚青年女性小腿的测定及相关因素分析

目的探讨中原未婚青年女性小腿美学标准的正常值,为小腿美容术提供参考和依据,并为人类形态学积累资料。方法测量531例健康未婚青年女性的身高、体质量、臀围、全腿长、小腿长、小腿粗围距胫骨点距离、小腿中围距胫骨点距离、小腿粗围和细围等项目,计算各测量值的均值和标准差,对其有关的各项指标进行相关性分析。结果身高（163．22±4．03）cm、体质量（53．82±6．12）kg、臀围（91．51±4．56）cm、全腿长（75．95±2．97）cm、小腿长（37．97±1．83）cm、小腿粗围距胫骨点距离（14．13±0．74）cm、小腿中围距胫骨点距离（18．99±0．92）cm、小腿最大围（34．91±1．82）cm、小腿最小围（20．30±1.06）cm。小腿长身高指数23．26±0．90、小腿长全腿长指数50．01±1．95、小腿最大围臀围指数38．18±1．66、小腿长围指数92．12±5．86、小腿围度指数58．21±2．84、小腿最粗点比例位置37．26±1．78。全腿长、小腿长、小腿粗围距胫骨点距离、小腿中点距胫骨点距离与身高、体质量和臀围均有关;小腿最大围、小腿最小围与身高无关,与体质量和臀围有关;小腿最大围臀围指数与身高、体质量无关;小腿最粗点比例位置、小腿围度指数与身高、臀围有关,与体质量无关;小腿长围指数与身高、体质量和臀围均有关;小腿长全腿长指数与身高、体质量和臀围均无关;小腿长身高指数与体质量和臀围有关。结论测量值为分析人类特征及中原地区青年女性小腿美容术提供了美学标准。     

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Background

Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear.

Questions/purposes

We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.

Methods

We measured alignment in 367 knees that underwent TKA and 60 sex- and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3° or ± 2°) at 1 year.

Results

The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6° in the TKA group and valgus 1.1° in the control group, and mean tibial plateau inclination was varus 8.3° in the TKA group and varus 5.4° in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers.

Conclusions

Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.     

Triple plating of tibia in a complex bicondylar tibial plateau fracture

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis （limb alignment） and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibialplateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.