全膝关节置换术股骨远端外翻角影响因素探讨

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摘要目的：研究人工全膝关节置换术（TKA）股骨远端外翻角（DFVR）变化，分析其影响因素。方法：收集2012年2月1日至2014年2月1日间因骨性膝关节炎入院行初次人工TKA的患者共222例作为研究对象，测量DFVR。观察并记录各研究对象的一般临床资料、股骨长度、股骨颈干角（FNSA）、股骨颈长度（FNL）、股骨弯曲角度（FBA）及股骨远端解剖轴外侧角（mLDFA）等参数，并分析与DFVR的相关性；定义FBA＞3°为股骨弯曲，分为弯曲组和非弯曲组，比较并分析2组在不同DFVR的力线不良发生率。结果：研究对象的平均DFVR为6.66°±2.06°（2.78°～12.84°），与FBA有强相关性（r=0.845，P＜0.01），与年龄及mLDFA有弱相关性（r=0.377、0.446，P＜0.01），与其余参数均无相关性（P＞0.05）。明显的股骨弯曲（FBA＞3°）的发生率为37.8%，弯曲组与非弯曲组在股骨远端外翻截骨角度为5°或6°时，力线不良的发生率（截骨误差＞3°）差异有统计学意义（P＜0.05），在股骨远端外翻截骨角度为7°时差异无统计学意义（P＞0.05）。结论：中国人中股骨弯曲发生率较高，且DFVR与股骨弯曲关系密切。

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关键词 ：股骨弯曲, 全膝关节置换术, 股骨远端外翻角

Abstract：Objective: To measure distal femoral valgus resection and determine influential factors in patients undergone total knee arthroplasty. Methods: Two hundred and twenty two patients planned to undergo primary TKA from February first 2012 to February first 2014 in the First Affiliated Hospital of Wenzhou Medical University were included. The clinical data of age, gender, height, weight, body mass index and the radiographic data of distal femoral valgus resection, femoral length, femoral neck length, femoral shaft-neck angle, femoral bowing angle and mechanical lateral distal femoral angle were recorded and analyzed. Results: The mean distal femoral valgus angle was 6.66°±2.06° (range: 2.78°-12.84°). The femoral bowing angle was the factor that showed the strongest correlation with this angle (r= 0.845, P<0.01). The mechanical lateral distal femoral angle and age showed only a weak correlation (r=0.377, 0.446, P<0.01), and other parameters showed no correlation (P>0.05). Apparent femoral bowing angle (>3° of bowing) was found in 84 (37.8%) cases. Cases with apparent femoral bowing had statistically significant higher potential cutting error than cases with non-femoral bowing when a 5° or 6° distal femoral valgus angle was chosen (P<0.05). Conclusion: Chinese races’ distal femoral valgus angles are mainly influenced by femoral bowing among femoral deformities in the coronal plane. Therefore, it is necessary to measure the distal femoral valgus angle preoperatively from coronal radiographs covering the whole femur.

Key words： knee arthroplasty femoral bowing distal femoral valgus resection

收稿日期: 2015-12-02

通讯作者: 陈雷，主任医师，教授，Email：chenlei689595@qq.com。

作者简介: 吴鹏（1988-），男，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2016/V46/I12/878

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