胫骨前肌肌腱在膝关节置换术胫骨髓外定位系统中的作用分析
The tibialis anterior tendon as anatomical landmark in the extramedullary alignment system of the total knee arthroplasty
目的 探讨胫骨前肌肌腱在膝关节置换术胫骨髓外定位系统的作用。 方法 59例行膝关节置换术中患者的59个下肢，用X线定位胫骨冠状位力线以及踝关节中点，并在皮肤上标志，标志胫骨前肌肌腱内侧缘纵轴，在内、外踝连线上测量胫骨前肌肌腱内侧缘距离踝关节中点的距离，测量胫骨力线与胫骨前肌肌腱交点到内、外踝连线距离，并用独立t检验做统计学分析。 结果 胫骨前肌肌腱内侧缘在内、外踝连线上与踝关节中点距离为(13.32±2.75) mm，胫骨前肌与胫骨力线交点与内外踝连线距离(71.23±6.45) mm，均有统计学意义(P<0.001)。 结论 胫骨前肌肌腱在胫骨远端有2个可以作为膝关节置换术中髓外定位系统中胫骨远端解剖标记，具有实际应用价值。
Objective To explore the effect of the tibialis anterior tendon in the total knee arthroplasty of the extramedullary alignment. Methods The ankle center and the tibial coronal alignment in 59 lower limbs of the 59 osteoarthritis were confirmed with X-ray and was marked in the skin, the medial border of tibialis anterior tendon was also marked in the skin. The distance of the tibialis anterior tendon to the ankle center was measured at the ankle line, the distance of junction of tibialis anterior tendon and tibial coronal alignment to the ankle line also was measured. The independent t test was performed for both distances. Results The distance of the tibialis anterior tendon to the ankle center was (13.32±2.75) mm (P<0.001), and the distance of the junction of the tibialis anterior tendon and the tibial alignment to the ankle line was (71.23±6.45) mm (P<0.001). Conclusion The tibialis anterior tendon has 2 points that could serve as the distal tibial anatomical landmark in extramedullary alignment of total knee arthroplasty, it could be applied in the total knee arthroplasty clinically.
Total knee arthroplasty / Tibialis anterior tendon / Alignment / Anatomical landmark
[1] Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? [J].J Arthroplasty, 2009, 24(6 Suppl):39-43.
[2] Schroer WC, Berend KR, Lombardi AV, et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011[J]. J Arthroplasty, 2013, 28(8 Suppl):116-119.
[3] Dalury DF. Observations of the proximal tibia in total knee arthroplasty[J]. Clin Orthop Relat Res, 2001, 389:150-155.
[4] Rajadhyaksha AD, Mehta H, Zelicof SB. Use of tibialis anterior tendon as distal landmark for extramedullary tibial alignment in total knee arthroplasty: an anatomical study[J]. Am J Orthop, 2009,38(3):E68-70.
[5] Sugimura N, Ikeuchi M, Izumi M, et al. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2014,22(11):2618-2622.
[6] Schneider M, Heisel C, Aldinger PR, et al. Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty[J]. J Arthroplasty, 2007,22(2):219-226.
[7] Dennis DA, Channer M, Susman MH, et al. Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty[J]. J Arthroplasty, 1993,8(1):43-47.
[8] Akagi M, Asada S, Mori S,et al. Estimation of frontal alignment error of the extramedullary tibial guide on the bi-malleolar technique: a simulation study with magnetic resonance imaging[J]. The Knee, 2012,19(6):836-842.
[9] Siston RA, Daub AC, Giori NJ, et al. Evaluation of methods that locate the center of the ankle for computer-assisted total knee arthroplasty[J]. Clin Orthop Relat Res, 2005,439:129-135.
[10]乔建民，季庆辉，杨建华，等. 超声对踝关节中心解剖标志的研究[J]. 中华临床医师杂志( 电子版)， 2012，6(1):226-228.
[11]欧云生，李怀先，赵玉峰. 胫骨应用解剖与胫骨型髓内分叉钉设计[J]. 实用骨科杂志， 2001，7(2):101-104.
[12]Burke DW, O'Flynn. Primary total knee arthroplasty[M]//Chapman MW, editor. Chapman's orthopedic surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2001:2885
国家自然科学基金（81101389）；广东省自然科学基金博士启动项目（s2011040003467）；惠州市科技计划项目（20120802）
京ICP备08002354号-3/
| 〈 |
|
〉 |
