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南京医科大学学报（自然科学版） 第42卷第9期
·1294 · Journal of Nanjing Medical University（Natural Sciences） 2022年9月

·临床研究·

TKA术中参照股骨后髁轴外旋3°放置股骨假体的准确性研究

周 皓，段 傲，刘久翔，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：通过下肢CT图像测量股骨髁通髁轴与股骨后髁轴的旋转度数，为人工全膝关节置换术（total knee arthroplasty，
TKA）术中股骨假体旋转定位提供参考。方法：回顾性分析2018年10月—2022年3月在南京医科大学第一附属医院骨关节外
科行TKA手术的283例患者的膝关节X线及下肢CT影像学资料。1名关节外科住院医师及1名资深关节外科主任医师分别
通过影像系统测量股骨外科通髁轴（surgical transepicondylar axis，sTEA）及股骨后髁轴（posterior condylar axis，PCA）间夹角的
度数。计算sTEA与PCA夹角及常规按照PCA外旋3°放置股骨假体TKA术后与sTEA的夹角。结果：sTEA相对于PCA平均外
旋1.63°（内旋3.79°至外旋7.87°）。常规将股骨假体参照PCA外旋3°放置时，只有163例（57.6%）患者TKA术后股骨假体旋转
在sTEA的±2°范围内，其中68例（24.0%）的患者股骨假体相对于sTEA内旋。结论：膝骨关节炎患者股骨远端旋转存在广泛的
差异性，常规参照PCA外旋3°放置股骨假体将会造成显著位置误差，影响TKA预后。应根据术前影像资料个性化制定TKA术
中股骨假体旋转力线。
［关键词］ 人工全膝关节置换术；股骨假体旋转；股骨外科通髁轴；股骨后髁轴
［中图分类号］ R687.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）09⁃1294⁃06
doi：10.7655/NYDXBNS20220915

Accuracy of 3° external rotation of femoral component to the posterior condylar axis in

TKA
ZHOU Hao，DUAN Ao，LIU Jiuxiang，LIU Feng *
Department of Orthopedics Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

［Abstract］ Objective：This study aims to provide references on the rotation of the femoral component during total knee arthroplasty
（TKA）by measuring the rotation degree of the surgical transepicondylar axis and the posterior condylar axis of the femoral condyles
on CT images. Methods：The X⁃ray and lower extremity CT imaging data of 283 patients who underwent TKA in the Department of
Bone and Joint Surgery，the First Affiliated Hospital of Nanjing Medical University from October 2018 to March 2022 were retrospected
in our study. One resident and one senior chief physician of joint surgery measured the angle between the surgical transepicondylar axis
（sTEA）and the posterior condylar axis（PCA）by the imaging system，respectively. The angle between sTEA and PCA and the angle
between femoral component and sTEA after routine placement of the femoral component with reference to 3° external to the PCA was
calculated. Results：The sTEA was on average 1.63° externally rotated to the PCA（range 3.79° internal to 7.87° external）. When the
femoral component was routinely placed at 3°external to PCA，only 163（57.6%）patients had femoral component rotation within ± 2 ° of
sTEA after TKA，of which 68（24.0%）patients had femoral component internal rotation to sTEA. Conclusion：There were extensive
differences in the rotation of the distal femur in patients with osteoarthritis. Routinely setting femoral rotation 3° external to the PCA
would cause significant position errors in femoral component，affecting the prognosis of TKA. Joint surgeons should individualize the
rotational alignment of the femoral component during TKA based on preoperative imaging data.
［Key words］ total knee arthroplasty；rotation of femoral component；surgical transepicondylar axis；posterior condylar axis
［J Nanjing Med Univ，2022，42（09）：1294⁃1298，1304］

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