Page 88 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第5期
·718 · Journal of Nanjing Medical University（Natural Sciences） 2021年5月

·临床医学·

TKA术中股骨内侧后髁软骨磨损对股骨假体旋转对线的影响

邵禹棋，王 瑞，陈哲峰，周 皓，刘 锋 *
南京医科大学第一附属医院骨科，江苏 南京 210029

［摘 要］ 目的：比较CT与MRI测量内翻性膝骨关节炎股骨后髁角（posterior condylar angle，PCA）的差异。方法：回顾性分析
2018年11月—2020年2月在南京医科大学第一附属医院骨关节外科行全膝关节置换术的71例患者（73例内翻骨关节炎膝关
节）的全下肢CT及膝关节MRI资料。分别使用CT及MRI图像对PCA进行测量，采用MRI图像测量股骨内外后髁及股骨远端
内外髁软骨厚度。同时测量标本股骨内外侧后髁软骨厚度，将测量结果进行比较及相关性分析。结果：根据CT图像测量的
PCA［（4.09 ± 1.39）°］显著大于MRI测量的PCA［（2.25 ± 1.01）°］（P＜0.01）。标本上股骨内侧后髁软骨厚度［（1.9 ± 0.6）mm］与
标本上股骨外侧后髁软骨厚度［（2.8 ± 0.6）mm］，MRI测量股骨内侧后髁的软骨厚度［（1.9 ± 0.6）mm］与MRI测量股骨外侧后髁
的软骨厚度［（2.8 ± 0.5）mm］，MRI测量股骨远端内侧髁软骨厚度［（1.3 ± 0.4）mm］与MRI测量股骨远端外侧髁软骨厚度［（2.5
± 0.4）mm］之间，差异均具有统计学意义（P＜0.01）。而标本股骨内外侧后髁软骨厚度与 MRI 测量值之间差异无统计学意义
（P＞0.05）。Pearson相关性分析结果显示，股骨外侧后髁软骨与股骨内侧后髁软骨厚度相差2 mm，CT测量PCA将比MRI测量
PCA大接近3°。结论：内翻性膝骨关节炎普遍存在股骨内侧后髁软骨的磨损，并对依据股骨后髁线确定的股骨假体旋转产生
显著影响。MRI与CT的术前测量存在显著差异，关节外科医生在制定术前计划时必须把这种差异考虑在内。
［关键词］ 内翻性膝骨关节炎；股骨内侧后髁；软骨磨损；假体旋转；影像学
［中图分类号］ R687.42 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）05⁃718⁃07
doi：10.7655/NYDXBNS20210514

Effect of cartilage wear of medial posterior femoral condyle on the rotational alignment of
femoral component during TKA

*
SHAO Yuqi，WANG Rui，CHEN Zhefeng，ZHAO Hao，LIU Feng
Department of Orthopedics Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

［Abstract］ Objective：This study aims to compare the differences between CT measured and MRI measured femoral posterior
condylar angle（PCA）in varus osteoarthritis knees. Methods：The CT data of lower⁃extremity and MRI data of involved knees in 71
patients（73 varus osteoarthritis knees）who underwent primary TKA at department of orthopedic surgery，Jiangsu Province Hospital
from November 2018 to February 2020 were retrospected in our study. The CT and MRI images were used to measure PCA
respectively. MRI images were also used to measure the cartilage thickness of femoral posterior condyles and distal femoral condyles.
At the same time，the thickness of femoral posterior condylar cartilage of specimens was also measured. The measurement results were
compared and analyzed for correlation. Results：The PCA⁃CT（4.09 ± 1.39）°was significant larger than PCA⁃MRI（2.25 ± 1.01）°（P <
0.01）. The MRI measured cartilage thickness of medial posterior condyle（1.9 ± 0.6）mm and cartilage thickness of lateral posterior
condyle（2.8 ± 0.5）mm，MRI measured cartilage thickness of medial distal femoral condyle（1.3 ± 0.4）mm and cartilage thickness of
lateral distal femoral condyle（2.5 ± 0.4）mm，cartilage thickness of medial posterior condyle of specimens（1.9 ± 0.6）mm and cartilage
thickness of lateral posterior condyle of specimens（2.8 ± 0.6）mm all presented significant difference between each other（P＜0.01）.
But there was no statistical difference between the cartilage thickness of medial and lateral posterior condyles measured by MRI and
that measured on the specimens（P＞0.05）.Also，Pearson correlation analysis results showed that：if 2mm cartilage thickness difference
exists between medial and lateral posterior condyle，almost 3° external malrotation was found between PCA ⁃ CT and PCA ⁃ MRI.

［基金项目］ 江苏省自然科学基金面上项目（BK20191492）
∗
通信作者（Corresponding author），E⁃mail：njliuf@163.com