全膝关节置换术前CT与X线影像规划的比较△

Comparison of CT and Xray image planning before total knee arthroplasty

摘要:

[目的] 探讨下肢全长CT 和膝关节CT 联合下肢全长负重位正位X 线片的全膝关节置换术前三维规划的差异。[方法] 回顾性分析2021 年10 月—2022 年6 月本院收治的20 例膝关节骨关节炎患者的临床资料，每例患者分别采用下肢全长CT、膝关节CT 联合下肢全长负重位正位X 线片进行术前三维规划，比较两种测量方法与实际值的差异及两种影像规划与实际假体尺寸差异。[结果] 两种测量方法术前规划的股骨外翻角、股骨前髁截骨量、股骨远端内侧截骨量、股骨后髁内侧截骨量、股骨后髁外侧截骨量差异均无统计学意义（P＞0.05），CT 测量的胫骨平台内侧截骨量[(4.1±1.3) mm vs (3.7±1.3) mm, P=0.007] 显著大于X 线测量。两种测量方法术前规划的股骨假体型号完全一致13 例（65.0%），不一致7 例（35.0%）；胫骨假体型号完全一致8 例（40.0%），不一致12 例（60.0%）。[结论] 基于两种影像的全膝关节置换术前三维规划中，股骨规划结果近似，胫骨规划参数存在差异。

Abstract:

[Objective] To compare the three-dimensional planning before total knee arthroplasty with full-length CT versus knee jointCT combined with full-length weight-bearing X ray. [Methods] Clinical data of 20 patients with knee osteoarthritis admitted to our hospitalfrom October 2021 to June 2022 were retrospectively analyzed. For each patient, preoperative three-dimensional planning was performed byfull-length lower extremity CT, and knee joint CT combined with full-length weight-bearing X ray. The difference between the two measure-ment methods and the actual value and the difference between the two image planning and the actual prosthesis size were compared. [Re-sults] There were no statistically significant differences in femoral eversion angle, cutting amounts of anterior condyle, distal medial bone,medial posterior condyle and lateral posterior condylebetween the two methods (P＞0.05). The bone cutting amount of medial tibial plateaumeasured by CT was significantly greater than that measured by X-ray [(4.1±1.3) mm vs (3.7±1.3) mm, P＜0.05]. The femoral component sizeplanned by the two methods was completely consistent in 13 cases (65.0%), while inconsistent in 7 cases (35.0%). There were 8 cases(40.0%) with identical tibia component and 12 cases (60.0%) with inconsistent tibia component. [Conclusion] Comparing the two imagetechniques used for the three dimensional planning of total knee arthroplasty, the planning parameters are similar in the femur, while differ-ent in the tibia.