下肢有伤、行动不便的病人在生活中少不了要使用拐杖辅助行走,尤其是手术后患腿制动和需避免负重的情况下,拐杖就充当了不可缺少的"腿"的角色.虽说拐杖使用方法简单,但多数人并不能正确和熟练使用它,甚至会因错误使用拐杖而导致意外损伤.今天就来说说正确的拄拐方法,以免错误使用而导致危险.

近年来发展的开放楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)被证明是治疗骨关节炎的有效手段,特别适合于相对年轻活跃的伴有胫骨内翻的前内侧骨关节炎患者[1-3].OWHTO经过胫骨近端内侧完成手术,与闭合截骨比较具有较大优势.OWHTO不用剥离肌肉,不用截断腓骨,避免了腓骨截骨相关的并发症,血管神经损伤、骨筋膜室综合征发生率低.开放截骨术可以更精确地调整下肢力线,分散下肢应力,使膝关节内侧间室得到充分减压的同时,也不过度增加外侧间室的压力.术者可取得位置良好的目标力线,可以使得胫骨高位截骨术获得良好的长期生存率[4-5].

目的 研究一种用于选择性激光烧结3D打印截骨导板的聚酰胺材料的机械、化学性能以及生物相容性.方法 机械性能研究包括材料断裂延伸率、拉伸模量、抗拉强度、维卡软化温度、负荷变形温度和磨损质量.化学性能研究包括还原物质、酸碱度、重金属总量、蒸发残渣和紫外吸光度.生物学评价内容包括体外细胞毒性、皮肤致敏和皮内刺激.检测机械性能、化学性能以及生物相容性,并对其结果进行评价.结果 机械性能:断裂延伸率为7.8％～22.3％,拉伸模量为1 664～1 982 MPa,抗拉强度为47.71～51.25 MPa,维卡软化温度为163.2～166.0℃,负荷变形温度为66.2～75.2℃,磨损质量为6.8～16.8 mg.化学性能符合GB19335-2003的要求.生物学评价:对体外细胞无潜在毒性影响,未发现皮肤致敏反应,未发现皮内刺激反应.结论 该聚酰胺材料具有良好的机械、化学性能以及生物相容性,可用于生产制造手术3D打印截骨导板.

目的 评价3D打印截骨导板辅助胫骨高位截骨术的准确性和安全性.方法 对2020年4月至2020年10月我院行3D打印导板辅助开放楔形行胫骨高位截骨术的22例(36膝)患者进行回顾性研究,其中男11例(16膝),女11例(20膝);平均年龄(41.1±15.8)岁.比较术前计划力线和术后力线的差异及胫骨平台后倾角的变化,统计手术时间、术中透视次数与术中、术后早期并发症情况.结果 22例平均手术时间(40.1±12.8)min,术中平均透视(13.3±4.5)次.胫骨近端内侧角(medial proximal tibial angle,MPTA)由术前(83.0±1.8).矫正至术后(90.1±2.3)°,P＜0.001.下肢力线比值(weight bearing line ratio,WBLR)由术前的(22.6±9.7)％调整至术后的(52.9±3.8)％,P＜0.001.术后MPTA(90.1±2.3)°,与术前计划MPTA(90.4±2.2)°相比,差异无统计学意义(P=0.159).术后WBLR为(52.9±3.8)％,与术前目标WBLR(54.4±3.3)％相比,差异有统计学意义(P=0.005),差值(1.5±3.1)％.术后胫骨平台后倾角(posterior tibial slope,PTS)平均为(10.2±3.3)°,与术前PTS(10.4±3.5)°相比,差异无统计学意义(P=0.077).合页骨折2例,其中Takeuchi Ⅰ型骨折1例,Ⅲ型骨折1例,骨折均愈合良好,无移位及矫正力线丢失.结论 3D打印截骨导板辅助开放楔形胫骨高位截骨术力线矫正精确,可有效维持胫骨平台后倾,具有良好的准确性和安全性.

OBJECTIVE To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty. METHODS A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact. EXCLUSION CRITERIA combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed. RESULTS Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line. CONCLUSION Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

目的 总结分析双平面开放楔形胫骨高位截骨术(open wedge high tibia osteotomy,OWHTO)术后系统康复疗效,为制订标准化康复方案提供参考.方法 应用双平面OWHTO治疗膝关节内侧骨关节炎患者27例(39膝),其中男12例,女15例;单侧15例,双侧12例.按年龄分为青年组(18～29岁)、中青年组(30～49岁)、中老年组(50～75岁),根据Takeuchi合页骨折分型制订相应康复方案,随访3～6个月.应用疼痛视觉模拟评分(visual ana-logue score,VAS)对所有患者术后第2天下地和术后3个月的疼痛进行评估、对患者术前及术后最远行走距离进行比较、记录患者完全脱离拐杖时间.结果 所有患者术后初次下地与术后3个月VAS疼痛评分比较差异有统计学意义(P＜0.05);18～29岁和50～75岁两组患者术前和术后3个月最远行走距离差异有统计学意义(P＜0.05),30～49岁组差异无统计学意义;18～29岁组患者平均2个月完全脱离拐杖,30～49岁和50～75岁组患者平均2.5个月完全脱拐.结论 双平面OWHTO是一种有效、安全的治疗膝关节内侧间室骨关节炎的手术方式,可以很好地改善疼痛、恢复活动能力,在制订标准化康复方案时应综合考虑患者的年龄、活动需求、术中情况等多方面因素.

目的 探讨应用Oxford单髁置换术治疗55岁及以下膝内侧单间室骨关节炎患者的早期疗效.方法 回顾性分析2014年1月至2016年12月在北京积水潭医院矫形骨科行Oxford活动平台单髁置换术治疗的47例(56膝)55岁及以下膝内侧单间室骨关节炎患者的病历资料.术前及末次随访记录患者的牛津大学膝关节评分(OKS)、视觉模拟评分(VAS)、膝关节活动度(ROM)及机械轴股骨胫骨角(mFTA),并分析患者术后并发症发生率及假体生存率.结果 手术年龄为(52.77±2.28)岁.随访时间为(42.16±9.60)个月.ROM由术前的(114.02±5.75)°提高至术后的(120.35±8.63)°,差异有统计学意义(P<0.05).VAS评分由术前的(6.14±0.86)分降低至术后的(1.18±1.38)分,差异有统计学意义(P<0.05).mFTA角由术前的(7.14±2.66)°改善至术后的(4.10±2.39)°,差异有统计学意义(P<0.001),且无膝关节内翻过度矫正.OKS评分由术前的(20.04±3.88)分提高至术后的(42.07±4.58)分,差异有统计学意义(P<0.001),优良率为91.1％.5例患者术后残留持续疼痛.随访期间,未发生其他严重并发症,假体生存率为100％.结论 Oxford单髁置换术可显著改善年轻膝内侧单间室骨关节炎患者的临床症状和膝关节功能,早期疗效满意.残留疼痛是Oxford单髁置换术后最常见的并发症.

患者女,69岁.主诉为双膝关节疼痛10年,加重伴活动受限2个月.患者10年前无明显诱因出现左膝关节疼痛,与活动相关,休息可缓解,无夜间痛.曾多次于外院行口服药、热敷等保守治疗.在治疗过程中症状逐渐加重,近2个月前疼痛加重,伴活动受限.下蹲、上下楼困难,步行小于500 m.入院后进行详细的体格检查.双下肢呈屈曲内翻畸形,双侧膝关节轻度肿胀,皮温不高,大腿肌肉萎缩.内侧关节间隙明显压痛,髌骨下摩擦感,股四头肌抗阻力试验(+);双膝活动受限.左膝关节屈伸活动15°～ 80°,内翻10°;右膝屈伸10° ～110°,内翻5°.浮髌征可疑阳性,髌股摩擦征阳性,前抽屉试验阴性,侧方应力试验阴性.双下肢足背动脉搏动良好,感觉运动良好,直腿抬高试验阴性.双侧膝、踝反射正常,Babinski征阴性.X线检查显示双膝关节内翻畸形畸形,软骨下骨硬化;关节周缘及熊骨上下极可见少量骨赞形成,髌骨关节面欠平整.髋膝踝角(HKA角):左171 °,右174°;关节线相交角(JLCA):左5.81°,右4.70°.择期予改良截骨法行双膝人工关节置换术(CR假体).术后复查X线片示双膝人工关节假体在位,HKA角:左178.42°,右176.42°(图1).术后3个月复查,患者可脱拐行走1～2 km,正常生活.

High tibial osteotomy (HTO) is an effective treatment for knee osteoarthritis. With the application of bi-planer open wedge osteotomy high tibial osteotomy and new angular stable locking plates, HTO has become more accuracy, minimally invasive and standard, achieved satisfactory long-term treatment outcome. The indications of HTO are expanding. We need to comprehensively consider whether the patient has varus deformity, the location and severity of the deformity, the stage of osteoarthritis, age and the demand of activity, as well as individual factors such as weight, gender, bone condition and joint activity, and strive to give the best individualized treatment to osteoarthritis patients in different stages.

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.

目的 评价Ilizarov外固定架固定踝关节融合术治疗终末期踝关节炎的临床效果.方法 对2016年5月至2017年12月我院行Ilizarov外固定架固定踝关节融合的20例终末期踝关节炎患者进行回顾性研究,其中男性12例,女性8例;年龄47～77岁,平均(59.05±7.83)岁.评估患者术后功能、融合成功率、并发症发生率以及合并畸形的矫正情况.结果 所有患者均获得骨性愈合,融合成功率100％.术后愈合时间3～6个月,平均(3.70±1.04)个月.1例出现伤口延迟愈合,1例出现针道感染,1例出现严重肿胀及张力水疱,无其他严重并发症发生.胫骨长轴与距骨关节面的内侧夹角(medialtibialtalarangle,MTTA)由术前的(86.84±6.26)°增加到(89.90±1.37)°,距骨前移距离由(5.50±3.97)mm减小到(2.85±2.72)mm,与术前相比差异均有统计学意义(P＜0.05).术后踝关节功能也有明显改善,AOFAS踝与后足评分由术前的(39.00±8.34)分增加至术后的(80.65±8.86)分(P＜0.001).结论 Ilizarov外固定架固定踝关节融合术,骨愈合成功率高,可矫正合并的踝关节对位及对线异常,有效地改善患者的踝关节功能,具有良好的效果.

Objective To investigate the effect of direct anterior approach (DAA) and posterior lateral approach (PLA) on leg length discrepancy (LLD) after bilateral total hip arthroplasty (THA). Method We retrospectively studied a series of cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip or osteoarthritis and rheumatoid arthritis that were treated by THA in the Beijing Jishuitan Hospital. These patients were divided into two groups, one for DAA group (n=22) and another for PLA group (n=24). There were 17 males and 5 females, the average age was (50±9) years (34-67 years) in DAA group; there were 18 males and 6 females, the average age was (48±7) years (37-62 years) in PLA group. The X ray images of bilateral hips were taken after surgery within one week for all patients. The LLD was analyzed for the two group patients. Result We used biological fixed prosthesis in all the patients. The average LLD before surgery was similar in two groups. The average LLD was (2.0±1.5)mm (0.5-6.8mm) for DAA group and (4.6±4.0)mm (0-14.8mm) for PLA group after surgery. There was statistical difference between the two groups (P＜0.05). The functional LLD that reported by the patients was significantly higher in PLA group than DAA group (P＜0.05). Conclusion Although bilateral THA can restore the leg length successfully, the DAA technique with supine position has the advantage of more accurately restoration of the leg length for bilateral THA.

目的 探讨直接前方入路(前入路)和后外侧入路(后入路)对小切口人工全髋关节置换术(THA)髋臼假体外展角的影响.方法 回顾分析2015年4月至2016年8月北京积水潭医院行小切口THA治疗的115例患者(151髋)的临床资料.按手术入路不同将病例分为前入路组和后入路组.前入路组包括55例患者(72髋),后入路组包括60例患者(79髋).2组患者的年龄、性别、BMI和病因等一般资料差异无统计学意义(P>0.05),具有可比性.术后3 d内摄双髋正位X线并测量髋臼假体外展角.随访观察患者术后人工髋关节脱位的发生情况.采用SPSS 18.0统计学软件对2组数据进行分析和比较.结果 全部患者使用生物固定型人工髋关节假体.手术切口长度前入路组(9.3±0.8)cm,后入路组(8.9±1.0)cm.髋臼假体外展角前入路组(39.1±4.2)°(30.1°～47.8°),后入路组(44.2±6.3)°(31.8°～62.1°).前入路组髋臼假体外展角全部在30°～50°内,后入路组中11髋(13.9％)的髋臼假体外展角>50°,组间差异有统计学意义(P<0.001).前入路组髋臼假体外展角误差为(3.3±2.5)°,小于后入路组的(5.5±5.1)°,差异有统计学意义(P<0.001).术后随访(22.2±3.5)个月,未见人工髋关节脱位病例.结论 与后外侧入路小切口THA相比,直接前方入路小切口THA髋臼假体外展角更准确.

Objective To investigate the safety and curative effect of pie crusting release technique for valgus knee in total knee ar-throplasty(TKA).Methods A retrospective study was performed on 20 cases(23 knees) who underwent TKA from October 2014 to May 2015.All the patients underwent TKA,and were followed up in 1,3,6 and 12 months after surgery.The X-ray images of the knee joint were taken and the full-length X-ray images were taken to observe the symptoms of peroneal nerve injury and access the score of the American knee association(KSS).Results Posterior-stabilized(PS) knees were used in 18 patients,legacy constrained condylar knees(LCCK) were used in 2 patients.All implants were cemented and the patella was not resurfaced.Pie crust release technique was effectively in TKA operation,and the depth was less than 5 mm.The average operating time were(79 ± 12) minutes,the average blood lose was (150 ± 30) ml,and there was no blood transfusion in all patients.The wound average drainage was (190 ± 70) ml.All the patients moved out of the bed on the first day after surgery.No peroneal nerve injury or palsy was found after surgery or during follow-up period.The KSS scores were improved from preoperative (39 ± 10) scores to postoperative (91 ± 6) scores,and the KSS scores were statistically significant different before and after surgery(P<0.05).Conclusion Pie crusting release technique is an effective method in treating valgus knee,the depth less than 5 mm was recommended for the safety distance between peroneal nerve and the cap-sule during surgery to get satisfactory soft tissue balance.

Objective To evaluate the short-term results of primary total hip arthroplasty(THA) with Corail prosthesis for the elderly patients.Methods A retrospective study was performed on 26 cases of elderly patients who were admitted and underwent primary THA from January 2013 to June 2016.The complications were recorded and the radiological changes were observed by X-ray.The clinical results were evaluated according to Harris scores.Results The patients in this group were followed up for 8 to 34 months,(20.8 ± 9.2) months on average.One case had crack fracture of the femoral calcar during operation,which was treated by circled wire fixation and healed afterwards.Four cases were with intermuscular,1 case had posterior tibial venous thrombosis,which were treated conservatively and healed.There was no infection,nervous or vascular injury happened.At the last time of follow up,subsidence of prosthesis was found in 1 case with 2.5mm distance.There was no loosening of the prosthesis and all prostheses achieved osseous fixation with a 100.0％ survivorship.All cases had good recovery of hip function and no thigh pain was observed in these cases.The mean Harris scores were improved from (44.8-± 10.9) score preoperatively to (86.0 ±6.0) score postoperatively.Conclusion The THA for elderly femoral patients with Corail stem can achieve excellent stability,great improvement of hip function and satisfied short term results.

Objective To evaluate the efficacy and safety of the open wedge distal femoral osteotomy with allograft for the valgus knee.Methods A retrospectively study was carried out on 23 unilateral open-wedge distal femur varus osteotomy cases, with a mean follow-up period of ( 59 ±7 ) months.The angle of correction, lower limb length, length of femoral mechanical axis, complications, and the knee injury and osteoarthritis outcome score ( KOOS) were analyzed.Paired t test was used to analysis the data by SPSS18.0.Results The average pre-and post-operative femoral tibial angle ( FTA) was (162 ±4)°and (173 ±2)°respectively; the difference was significant (t =11.796, P<0.01).The pre-and post-operative length differences of the femoral mechanical axis were (17 ±9) mm and (12 ±9) mm respectively;the difference was not significant (t =1.884, P>0.05).The pre-and post-operative leg length differences were (23 ±12) mm and (14 ±10) mm respectively; the difference was significant (t =5.428, P <0.01).No non-union was observed.The postoperative KOOS scores significantly increased (P <0.05 ).Conclusion This study showed that the lateral open-wedge distal femoral osteotomies ( OWDFO) could be a safe and effective operation for the patients with valgus knee.

Objective To test the efficacy and safety of a modified closing wedge high tibial osteotomy ( CWHTO) procedure for tibia vara.Methods In this prospective study, the young adults with genu varum and mild medial arthritis changes were included, 17 males and 29 females.A modified CWHTO was performed at the distal one third of the tibial tuberosity.A Tomofix lateral proximal tibial plate was used for internal fixation.The pre/post-operative femoro-tibial angle ( FTA), pain relief, patellar height, and posterior tibial slope were evaluated by paired t test with SPSS 1.0.Adverse events were monitored.Results Seventy-five knees from 46 patients aged ( 27 ±6 ) years ( range, 14 -43 years ) underwent the modified CWHTO procedure.After a follow-up time of ( 55 ±8 ) months ( range, 42-83 months) , the postoperative FTA was ( 173.30 ±2.00 ) °, and comparing with the preoperative FTA (186.20 ±5.10)°, the correction was (12.4°±4.7°); the difference was significant (t=15.971,P<0.01).The pain was also relieved according to the visual analog scale(VAS) score.The posterior tibial slope was ( 2.80 ±1.90 ) °which was ( 3.0 ±2.3 ) °smaller than the preoperative tibial slope, and the difference was significant (t=6.869,P<0.001), while there was no significant change in patella height. Bone union was observed in all the patients.The delayed union occured in four knees, the peroneal nerve&nbsp;lesion was found in five knees causing partial paralysis and/or sensory loss, and infections occurred in two knees.Three patients underwent the second surgery.All the adverse events were successfully treated except for one case of extensor hallucis longus muscle paralysis.Conclusion The modified CWHTO procedure is efficient and safe for the correction of tibia vara in young patients.

Objective To explore the influence of Tri-lock and Summit prosthesis on femoral anteversion angle. Methods A compar-ative prospective study was performed on 64 patients with total hip arthroplasty( THA) ,32 cases with Tri-lock prosthesis and other 32 cases with Summit prosthesis. CT images were used to calculate the preoperative autologous femoral anteversion angles and postopera-tive femoral-prosthesis angles,and they were compared between the two groups. Meanwhile,the anteversion angles between preoperative CT image and postoperative image were also compared in each case. Results Postoperative femoral-prosthesis angle increased when compared with preoperative autologous femoral anteversion angle in all cases(P<0. 01). While,there were no statistical differences of the femoral-prosthesis angles between Tri-lock group and Summit group(P>0. 05). Conclusion Tri-lock and Summit prosthesis have the equivalent effect on the adjustment of femoral angle in THA.

OBJECTIVE:To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life (QOL) and function improvement.METHODS:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications. In this study, 13 patients admitted to Department of Adult Reconstructive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included. Questionnaires SF-36 were used to evaluate the QOL. Harris hip score, American Knee Society Score (KSS) were used to evaluate the joint function. The patients were evaluated before surgery to the latest follow up.RESULTS:SF-36 has changed as follow: physical function 4.17 ± 14.43 → 65.83 ± 24.76, role physical 25.00 ± 26.11 → 60.42 ± 45.8, bodily pain 23.83 ± 21.41 → 76.88 ± 20.89, general health 53.33 ± 33.87 → 76.67 ± 14.67, vitality 50.42 ± 17.25 → 71.67 ± 16.28, social functioning 29.17 ± 33.50 → 73.96 ± 33.90, role emotional 22.08 ± 35.61 → 77.77 ± 41.03, mental health 53.33 ± 25.70 → 82.67 ± 14.41, which indicated that they all improved greatly after the surgery (P < 0.05). Harris score increased from 37.68 ± 14.71 before the surgery to 83.36 ± 13.54 after the surgery. KSS has also showed sharp improvement (P < 0.001) in both clinical score (42.52 ± 23.83 → 77.74 ± 20.67) and function score (-2.61 ± 22.56 → 65.65 ± 30.76).CONCLUSION:Multiple arthroplasty is one of the most effective methods which can markedly improve the quality of life in patients with multiple joints disease. But complications are common and joint functions are relatively poor.

[目的]测量国人膝骨关节炎患者在胫骨预定截骨平面上经胫骨平台几何中心点的胫骨平台最大横轴(maximal mediolateral axis)垂线、胫骨后髁连线(posterior tibial condylar line)垂线与Akagi轴线之间的夹角,以及经髌腱止点的胫骨横截面上胫骨平台中心投影点与胫骨结节中内1/3连线与Akagi轴线的夹角,并与正常入群比较.分析上述角度与冠状面下肢力线是否存在相关性.[方法]选择2011年12月～2012年12月间75例行膝关节置换的患者,术前行患侧膝关节CT扫描,共112膝,按照冠状面下肢力线进行分组,其中内翻膝(内翻组)92例,外翻膝(外翻组)20例,男18人,女57人,平均年龄(65.5±7.9)岁(45 ～81岁).通过Mimics软件进行三维CT重建后,在胫骨平台下8 mm预定截骨面上经胫骨平台中心点测量胫骨最大横轴垂线及胫骨后髁连线垂线与Akagi轴线之间的夹角;测量经髌腱止点的胫骨横截面上胫骨平台中心投影点与胫骨结节中内1/3连线与Akagi轴线的夹角,并与正常人群(正常组)比较.探讨上述角度是否与性别、年龄、aLDFA、mFTA、aMPTA相关.[结果]胫骨后髁连线垂线与Akagi轴线的夹角三组间均存在差异,正常组及内翻组胫骨最大横轴垂线及胫骨平台中心投影点与胫骨中内1/3连线与Akagi轴线之间的夹角小于外翻组.[结论]按照胫骨结节中内1/3处放置假体容易使假体处于过度 外旋状态,在预定截骨平面确定胫骨假体旋转时应当考虑到Akagi轴线与胫骨平台中心的关系.