Home About us Articles Multimedia Search Instructions Login 
IF 2017: 1.596 (® Clarivate Analytics)
Total Cites: 7606
Q2 in Medicine, General & Internal
Follow Us
Follow Us
  • Users Online: 1931
  • Home
  • Print this page
  • Email this page
ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 21  |  Page : 2531-2536

An innovative three-dimensional method for identifying a proper femoral intramedullary entry point in total knee arthroplasty


1 Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
2 Department of Orthopaedics, China-Japan Friendship Hospital, Beijing 100029, China
3 Department of Orthopaedics, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

Correspondence Address:
Prof. Wan-Shou Guo
Department of Orthopaedics, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.239208

Rights and Permissions

Background: Identification of the proper femoral intramedullary (IM) access point is an important determinant of final implant position in IM-guided total knee arthroplasty (TKA). The aim of this study was to identify the optimal entry point in Chinese participants using a new three-dimensional method. Methods: A series of computed tomography scans of 44 femurs in Chinese participants from October 2014 to October 2015 were imported into Mimics 17.0 software to identify the optimal entry point. The apex of the intercondylar notch (AIN) was used as the reference bony anatomical landmark to identify the proper entry point to insert the IM rod. The statistical significance was calculated on the basis of a 5% level (P < 0.05) using the Student's t-test. Results: For the males, the average ideal entry point was 1.49 mm medial and 13.39 mm anterior to the AIN. The values were 1.77 mm medial and 15.29 mm anterior to the AIN in females. A significant difference was present between males and females (13.39 ± 2.46 mm vs. 15.29 ± 3.44 mm, t = 2.124, P = 0.040). When using the recommended location as the entry point for the IM rod, the mean potential error differed significantly from the femoral trochlear groove (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.27° ± 0.32°, t = −4.166, P <0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.79° ± 0.70°, t = 7.155, P < 0.001; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.15° ± 0.35°, t = 3.940, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.76° ± 0.83°, t =5.574, P < 0.001). A significant difference was present between the recommended point and the point 10 mm anterior to the origin of the posterior cruciate ligament (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.53° ± 0.43°, t = 5.948, P < 0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.15° ± 0.75°, t = 3.152, P = 0.003; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.28° ± 0.42°, t = −4.632, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.40° ± 0.93°, t = 3.763, P = 0.001). Conclusions: The technique described here is an innovative method for swift, easy, and accurate access to the medullary canal during TKA, and it can optimize the position and orientation of the prosthetic components in knee arthroplasty.

 

 Abstract in Chinese

一种新的确定全膝关节置换术中股骨髓内定位入针点的三维重建方法

摘要

背景:股骨髓内定位进针点的准确选择是决定全膝关节置换术最终股骨假体位置的关键因素。本研究旨在通过一种新的三维重建的方法来确定中国人群最佳的股骨进针点。

方法:收集自2014年10月至2015年10月期间下肢CT的数据,并将其导入软件Mimics 17.0中,通过三维重建来确定最佳的髓内定位进针点。使用髁间窝顶点来作为骨性解剖标志来确定合适的进针点。统计学分析采用t检验,p<0.05认为有统计学意义。

结果:对于男性受试者来说,平均的进针点位于髁间窝顶点向内1.49mm及向前13.39mm,对于女性来说则是髁间窝顶点偏内1.77mm及偏前15.29mm。男性与女性的结果之间存在统计学差异(13.39±2.46mm vs 15.29±3.44mm, t=2.124, p=0.040)。当使用推荐的进针点时,潜在的平均误差与使用股骨滑车沟中点时存在统计学差异(男性在冠状面平均的潜在误差:0.93±0.24° vs 1.27±0.32°, t=-4.166, p<0.001;男性矢状面误差:1.40 ± 0.42° vs 2.79±0.70°, t=-7.155, p<0.001; 女性冠状面误差:0.73±0.28° vs 1.15±0.35°, t=-3.940, p<0.001;女性矢状面误差:1.48±0.47° vs 2.76±0.83°,t=-5.574, p<0.001)。而推荐进针点的潜在误差与后交叉韧带止点前10mm的位置作为进针点之间也存在统计学差异(男性在冠状面平均的潜在误差: 0.93±0.24° vs 1.53±0.43°, t=-5.948, p<0.001;男性矢状面误差: 1.40 ± 0.42° vs 2.15±0.75°, t=-3.152, p=0.003; 女性冠状面误差:0.73±0.28° vs 1.28±0.42°, t=-4.632, p<0.001;女性矢状面误差: 1.48±0.47° vs 2.40±0.93°, t=-3.763, p=0.001)。

结论:本研究提供了一种方便、快捷、准确的确定髓内定位进针点的方法,可以使进针点更准确,从而使股骨假体位置和方向更加准确。



[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed468    
    Printed45    
    Emailed0    
    PDF Downloaded80    
    Comments [Add]    

Recommend this journal

 

京ICP备05052599号