• 昆明醫(yī)科大學第一附屬醫(yī)院運動醫(yī)學科（昆明，650032）;

目的 綜述人工全膝關節(jié)置換術中股骨遠端旋轉力線定位標志的研究進展。 方法廣泛查閱近年國內(nèi)外股骨遠端旋轉力線相關文獻，并對其進行綜合分析。 結果若假體旋轉力線對位不良將導致諸如髕骨脫位、彈響、磨損、髕前疼痛等多種髕股關節(jié)并發(fā)癥。人工全膝關節(jié)置換術中確定股骨假體旋轉力線的方法較多，常用方法包括股骨上髁軸線、前后軸線、股骨后髁線、屈曲間隙平衡技術、計算機導航技術等。正確選擇旋轉力線，對減少術后并發(fā)癥和降低假體翻修率均至關重要。目前人工全膝關節(jié)置換術中選擇合適的參照軸以保證股骨假體旋轉力線對位的準確性仍有爭議。 結 論股骨假體旋轉力線是影響人工全膝關節(jié)置換術預后極其重要的環(huán)節(jié)。確定股骨假體旋轉力線的方法有待進一步改進。

引用本文： 胡猛,李彥林,仝路. 股骨遠端旋轉力線定位標志研究進展. 中國修復重建外科雜志, 2013, 27(1): 54-57. doi: 復制

1. Confalonieri N, Manzotti A, Pullen C, et al. Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg, 2005, 71(6): 703-709.
2. Ensini A, Catani F, Leardini A, et al. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res, 2007, (457): 156-162.
3. Chin PL, Yang KY, Yeo SJ, et al. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty, 2005, 20(5): 618-626.
4. Incavo SJ, Wild JJ, Coughlin KM, et al. Early revision for component malrotation in total knee arthroplasty. Clin Orthop Relat Res, 2007, (458): 131-136.
5. Scuderi GR, Komistek RD, Dennis DA, et al. The impact of femoral compontent rotation alignment on condylar lift-off. Clin Orthop Relat Res, 2003, (410): 148-154.
6. Luo CF, Koshino T, Takeuchi R, et al. Reliability of the transepicondylar line as a parameter of femoral axial alignment. J Orthop Sci, 2001, 6(5): 373-377.
7. 謝詩娟, 白波, 劉琦, 等. 股骨髁旋轉力線在三維重建圖像中的測量. 廣州醫(yī)學院報, 2008, 36(4): 24-26.
8. Yoshino N, Takai S, Ohtsuki Y, et al. Computed tomography measurement of the surgical and clinial transepicondylar axis of the distal femur in osteoarthritic knees. J Arthoplasty, 2001, 16(4): 493-497.
9. Akagi M, Matsusue Y, Mata T, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res, 1999, (366): 155-163.
10. Lanchiewicz PF, Soileau ES. Patella maltracking in posterior stabilized total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 155-158.
11. 李新勝, 姜建威, 儲小兵, 等. 股骨后髁角的影像學測量臨床價值. 南京醫(yī)科大學學報, 2006, 26(5): 371-372.
12. Schnurr C, Nessler J, König DP. Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty? Int Orthop, 2009, 33(6): 1561-1565.
13. 戚盈杰, 胡月正, 吳劍彬, 等. 全膝關節(jié)置換術股骨及脛骨假體旋轉定位研究進展. 國際骨科學雜志, 2011, 32(4): 221-223.
14. Picard F, Gregori A, Dean F, et al. Computer-assisted dynamic total knee arthroplasty using Whisiteside’s line for alignment. Orthopedies, 2006, 29(10 Suppl): S104-107.
15. Arima J, Whiteside LA, McCarthy DS, et al. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. J Bone Joint Surg (Am), 1995, 77(9): 1331-1334.
16. Victor J, van Doninck D, Labey L, et al. A common reference frame for describing rotation of the distal femur: a CT-based kinematic study using cadavers. J Bone Joint Surg (Br), 2009, 91(5): 683-690.
17. Middleton FR, Palmer SH. How accurate is Whiteside, s line as a reference axis in total knee arthroplasty? Knee, 2007, 14(3): 204-207.
18. Dennis DA, Komistek RD, Kim RH, et al. Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 102-107.
19. Witoolkollachit P, Seubchompoo O. The comparison of femoral component rotational alignment with transepicondylar axis in mobile bearing TKA, CT-scan study. J Med Assoc Thai, 2008, 91(7): 1051-1058.
20. Lee DS, Song EK, Seon JK, et al. Effect of balanced gap total knee arthoplasty on intraoperative laxities and femoral component rotation. J Arthroplasty, 2011, 26(5): 699-704.
21. Shrinand V Vaidya, Aditya V Maheshwari, Rajesh M Gadhiya, et al. Computed tomographic evaluation of femoral component rotation in total knee arthroplasty: a comparison between trans-epicondylar and balanced gap techniques. 中國矯形外科雜志, 2008, 16(12): 908-912.
22. Biasca N, Wirth S, Bungartz M. Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee, 2009, 16(1): 22-29.
23. Zhang GQ, Chen JY, Chai W, et al. Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures: a randomized clinical trial. J Bone Joint Surg (Am), 2011, 93(13): 1190-1196.
24. Zhang XL, Zhang W, Shao JJ, et al. Rotational alignment in total knee arthroplasty: nonimage-based navigation system versus conventional technique. Chin Med J (Engl), 2012, 125(2): 236-243.
25. 張聞, 邵俊杰, 張先龍. 計算機導航對人工全膝關節(jié)置換術下肢旋轉對線的影響. 中華骨科雜志, 2008, 28(10): 819-823.
26. Siston RA, Patel JJ, Goodman SB, et al. The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg (Am), 2005, 87(10): 2276-2280.
27. Cheng T, Zhang G, Zhang X. Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res, 2011, 171(2): 590-600.
28. van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, et al. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop, 2011, 35(6): 845-850.
29. Siston RA, Cromine MJ, Gold GE, et al. Averaging different alignment axes improve femoral rotation alignment in computer-navigated total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(10): 2098-2104.
30. Cinotti G, Ripani FR, Sessa P, et al. Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty. Int Orthop, 2012, 36(8): 1595-1600.
31. 羅吉偉, 金大地, 黃美賢, 等. 股骨遠端旋轉力線中的測量及其臨床意義. 中國臨床解剖學雜志, 2007, 25(3): 285-287.
32. Tashiro Y, Uemura M, Matsuda S, et al. Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1463-1469.
  1. 1. Confalonieri N, Manzotti A, Pullen C, et al. Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg, 2005, 71(6): 703-709.
  2. 2. Ensini A, Catani F, Leardini A, et al. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res, 2007, (457): 156-162.
  3. 3. Chin PL, Yang KY, Yeo SJ, et al. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty, 2005, 20(5): 618-626.
  4. 4. Incavo SJ, Wild JJ, Coughlin KM, et al. Early revision for component malrotation in total knee arthroplasty. Clin Orthop Relat Res, 2007, (458): 131-136.
  5. 5. Scuderi GR, Komistek RD, Dennis DA, et al. The impact of femoral compontent rotation alignment on condylar lift-off. Clin Orthop Relat Res, 2003, (410): 148-154.
  6. 6. Luo CF, Koshino T, Takeuchi R, et al. Reliability of the transepicondylar line as a parameter of femoral axial alignment. J Orthop Sci, 2001, 6(5): 373-377.
  7. 7. 謝詩娟, 白波, 劉琦, 等. 股骨髁旋轉力線在三維重建圖像中的測量. 廣州醫(yī)學院報, 2008, 36(4): 24-26.
  8. 8. Yoshino N, Takai S, Ohtsuki Y, et al. Computed tomography measurement of the surgical and clinial transepicondylar axis of the distal femur in osteoarthritic knees. J Arthoplasty, 2001, 16(4): 493-497.
  9. 9. Akagi M, Matsusue Y, Mata T, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res, 1999, (366): 155-163.
  10. 10. Lanchiewicz PF, Soileau ES. Patella maltracking in posterior stabilized total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 155-158.
  11. 11. 李新勝, 姜建威, 儲小兵, 等. 股骨后髁角的影像學測量臨床價值. 南京醫(yī)科大學學報, 2006, 26(5): 371-372.
  12. 12. Schnurr C, Nessler J, König DP. Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty? Int Orthop, 2009, 33(6): 1561-1565.
  13. 13. 戚盈杰, 胡月正, 吳劍彬, 等. 全膝關節(jié)置換術股骨及脛骨假體旋轉定位研究進展. 國際骨科學雜志, 2011, 32(4): 221-223.
  14. 14. Picard F, Gregori A, Dean F, et al. Computer-assisted dynamic total knee arthroplasty using Whisiteside’s line for alignment. Orthopedies, 2006, 29(10 Suppl): S104-107.
  15. 15. Arima J, Whiteside LA, McCarthy DS, et al. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. J Bone Joint Surg (Am), 1995, 77(9): 1331-1334.
  16. 16. Victor J, van Doninck D, Labey L, et al. A common reference frame for describing rotation of the distal femur: a CT-based kinematic study using cadavers. J Bone Joint Surg (Br), 2009, 91(5): 683-690.
  17. 17. Middleton FR, Palmer SH. How accurate is Whiteside, s line as a reference axis in total knee arthroplasty? Knee, 2007, 14(3): 204-207.
  18. 18. Dennis DA, Komistek RD, Kim RH, et al. Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 102-107.
  19. 19. Witoolkollachit P, Seubchompoo O. The comparison of femoral component rotational alignment with transepicondylar axis in mobile bearing TKA, CT-scan study. J Med Assoc Thai, 2008, 91(7): 1051-1058.
  20. 20. Lee DS, Song EK, Seon JK, et al. Effect of balanced gap total knee arthoplasty on intraoperative laxities and femoral component rotation. J Arthroplasty, 2011, 26(5): 699-704.
  21. 21. Shrinand V Vaidya, Aditya V Maheshwari, Rajesh M Gadhiya, et al. Computed tomographic evaluation of femoral component rotation in total knee arthroplasty: a comparison between trans-epicondylar and balanced gap techniques. 中國矯形外科雜志, 2008, 16(12): 908-912.
  22. 22. Biasca N, Wirth S, Bungartz M. Mechanical accuracy of navigated minimally invasive total knee arthroplasty (MIS TKA). Knee, 2009, 16(1): 22-29.
  23. 23. Zhang GQ, Chen JY, Chai W, et al. Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures: a randomized clinical trial. J Bone Joint Surg (Am), 2011, 93(13): 1190-1196.
  24. 24. Zhang XL, Zhang W, Shao JJ, et al. Rotational alignment in total knee arthroplasty: nonimage-based navigation system versus conventional technique. Chin Med J (Engl), 2012, 125(2): 236-243.
  25. 25. 張聞, 邵俊杰, 張先龍. 計算機導航對人工全膝關節(jié)置換術下肢旋轉對線的影響. 中華骨科雜志, 2008, 28(10): 819-823.
  26. 26. Siston RA, Patel JJ, Goodman SB, et al. The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg (Am), 2005, 87(10): 2276-2280.
  27. 27. Cheng T, Zhang G, Zhang X. Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res, 2011, 171(2): 590-600.
  28. 28. van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, et al. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop, 2011, 35(6): 845-850.
  29. 29. Siston RA, Cromine MJ, Gold GE, et al. Averaging different alignment axes improve femoral rotation alignment in computer-navigated total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(10): 2098-2104.
  30. 30. Cinotti G, Ripani FR, Sessa P, et al. Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty. Int Orthop, 2012, 36(8): 1595-1600.
  31. 31. 羅吉偉, 金大地, 黃美賢, 等. 股骨遠端旋轉力線中的測量及其臨床意義. 中國臨床解剖學雜志, 2007, 25(3): 285-287.
  32. 32. Tashiro Y, Uemura M, Matsuda S, et al. Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1463-1469.