踝间线足背动脉在全膝关节置换术髓外定位中的临床应用

目的探讨踝关节力学中心体表标志点,为全膝关节置换术(TKA)下肢力线的准确定位提供依据。方法对64例膝骨关节炎(OA)终末期患者实施初次TKA治疗,股骨侧采用髓内定位,胫骨侧采用髓外定位,实验组(34例)踝关节力学中心位于踝间线足背动脉处,对照组(30例)定位则按传统方法进行。术后测量患者胫骨假体胫骨角及后倾角。结果患者均获得随访,时间4~6年。胫骨假体胫骨角平均度数:实验组为(2.1±0.2)°,对照组为(2.6±0.1)°,差异有统计学意义(P0.05);胫骨假体后倾角:实验组为(3.1±0.2)°,对照组为(3.3±0.1)°,差异无统计学意义(P0.05)。实验组胫骨假体力线优于对照组。结论踝间线足背动脉定位可靠,其标示简单易行,能提高胫骨假体力线的精确度,不失为TKA术中踝关节力学中心定位的理想参考。

Clinical application of the dorsalis pedis artery crossing the intermalleolar line for extramed-ullary location in total knee arthroplasty

Objective To explore the body surface landmark about dynamics centre on ankle , and in order to provide a reasonable basis for clinical treatment for accurate positioning in lower limb alignment in total knee arthroplasty ( TKA) .Methods Sixty-four cases with end stage knee osteoarthritis were treated with primary TKA .The cases were treated with intramedullary location by distal femoral osteotomy .The way that extramedullary location was adopt-ed by proximal tibia osteotomy .Dynamics centre on ankle was positioned on the dorsalis pedis artery crossing the in-termalleolar line(were pre-operatively marked) in experimental group(34 cases), in control group(30 cases), was positioned on traditional method .Those tibial angles and posterior slope angles of components were measured .Re-sults All the patients were regularly followed up for 4~6 years after operation .The average degree of two groups:the experimental and control group for prosthesis tibial angle was (2.1 ±0.2)°and (2.6 ±0.1)°, respectively,the differences between two groups had statistics significance (P<0.05).The posterior slope angle of tibial prosthesis of two groups was (3.1 ±0.2)°and (3.3 ±0.1)°, respectively,the differences had no statistical significance (P>0.05).The experimental group was better than the control group in tibial component alignment .Conclusions The dorsalis pedis artery crossing the intermalleolar line is reliable to positioning .Its marking method is simple and practi-cable .The positioning has the ability to improve the accuracy of tibial component alignment , and is ideal reference to dynamics centre on ankle in TKA .This method deserves the clinical expansion application .