Study Of Imageology For Varus Inclination Of The Proximal Tibia And Rotational Alignment Of The Distal Femur On Chinese Adults And Its Significance In TKA

PARTⅠStudy of imageology for Varus Inclination of the Proximal Tibia on Chinese Adults and its Significance in TKAObjective to explore varus inclination of the proximal tibia on Chinese adults and try to find out the method of study on varus inclination of the proximal tibia with X-Ray. Provide the reference data for orthopedics surgeons to perform the TKA therapy efficiently for Chinese.when surgeons determine the femoral component to be externally rotated by amount degrees. Methods There were 102 Chinese adults,106 normal knees.male (knee)/female (knee)=50(52)/52(54),left/right=47/59. Standardized anteroposterior radiographs of the entire lower legs were moved to personal computer,then measured Angle PT(angle between tibial articular margins and a line perpendicular to the tibial mechanical axis),using software of AutoCAD2007.When got the values,gave them a statistical analysis of gender and side with SPSS10.0.and were compared statistically them with Angle PT of Westener,constant 3°,the level of significance was p<0.05. Results angle PT:4.66°士1.09°(2.12°-7.47°),male 4.83°士1.14°,female 4.49°士1.03°,left 4.49°士1.08°,right 4.79°士1.10°. angle PT have no difference between sex and side knees ,there is difference between angle PT of Chinese and angle PT of Westener,constant 3°. Conclusion Chinese has a more varus inclination of the proximal tibia than that of the Western's.During TKA for Chinese,the femoral component should be externally rotated 5°which is greater than 3°to get the optimum rotational orientation,and avoid rotating internally femoral component.PARTⅡStudy of imageology for posterior condylar line of the Distal Femur on Chinese Adults and its Significance in TKAObjective to explore the parameter of posteriorcondylar angle on Chinese adults and try to find out the method of study on posteriorcondylar angle with CT image. Provide the valuable data for Chinese manufacturers to devise the knee component fitting for Chinese adults,and provide the reference data for orthopedics surgeons to perform precise alignment in Total Knee Arthroplasty (TKA) for Chinese. Methods There were 86 Chinese adults,106 normal knees.male (knee)/female (knee)= 47(53) /39(53),left/right=54/52.The CT scan (layer distance set at 0.75mm)was employed in the distal femur,The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the knee joint.The CT images of cross sections of the distal femur across lateral and medial femoral epicondyle were moved to personal computer,then measured PCA using software of AutoCAD2007. When got the values,gave them a statistical analysis of gender and side with SPSS10.0.and were compared statistically them with Angle PT ,constant 3°,the level of significance was p<0.05. Results PCA:4.80°士1.23°(1.65°-7.49°),male 4.94°士1.24°,female 4.67°士1.21°,left 4.87°士1.24°,right 4.73°士1.22°.PCA have no difference between sex and side knees ,there is no difference between PCA and angle PT,But difference between PCA and constant 3°were significant. Conclusion PCA may be looked on the quantitative angle of external rotation of the femoral component,PCA on Chinese adults is greater than that of the Western's obviously,so in the TKA for Chinese,the malalignment will likely occur if the rotational alignment is performed according to Western style,the external 3°to the posterior condylar line in distal femur;The CT scan was employed in the distal femur,which was looked on as a method to judge accurate of rotational alignment of the distal femur.PARTⅢStudy of imageology for anterior posterior line of the Distal Femur on Chinese Adults and its Significance in TKAObjective to explore clinical significance of anterior posterior line of distal femur on Chinese adults in TKA. Methods There were 86 Chinese adults,106 normal knees.male (knee)/female (knee)= 47(53)/39(53),left/right=54/52.The CT scan (layer distance set at 0.75mm)was employed in the distal femur,The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the knee joint.The CT images of cross sections of the distal femur across lateral and medial femoral epicondyle were moved to personal computer,then measured ATA(angle between anterior posterior line and surgical transepicondylar axis),APA(angle between anterior posterior line and posterior condylar line) andA-PA(angle between perpendicularity of anterior posterior line and posterior condylar line ) using software of AutoCAD2007. When got the values,gave them a statistical analysis of gender and side with SPSS10.0.and were compared statistically them with Angle PT ,constant 3°,the level of significance was p<0.05. Results ATA:89.79°士1.22°(86.58°一93.26°),male 89.89°士1.10°,female 89.70°士1.35°,left 89.63°士1.11°,right 89.96°士1.32°,APA:84.84°士1.83°(78.17°-89.07°),male 84.96°士1.66°,female 84.72°士1.99°,left 84.50°士2.03°,right 85.19°士1.54°,A-PA:5.16°士1.83°(0.93°-11.83°),male 5.04°士1.66°,female 5.28°士1.99°,left 5.50°士2.03°,right 4.81°士1.54°. All the parameters have no difference between sex and side knees ,there is no difference between ATA and constant 90°,but difference between APA and constant 90°were significant; there is no difference among angle PT,PCA,A-PA,but difference between angle PT,PCA,A-PA and constant 3°were significant. Conclusion The anterior posterior line of distal femur may be considered a reliable mark of rotational alignment in TKA,but a part of them have more variability in partial individual ,and the accurate of rotational alignment was influenced seriously because of trochlear wear. So in the TKA for Chinese, The section of femoral posteriorcondyle should be external 5°to the posterior condylar line according to anterior posterior line of distal femur to obtain the optimum rotational orientation.PARTⅣStudy of imageology for transepicondylar line of the Distal Femur on Chinese Adults and its Significance in TKAObjective To explore clinical significance of transepicondylar axis of distal femur on Chinese adults in TKA, to explore relationship and reliability of rotational alignment of the distal femur. Methods There were 86 Chinese adults,106 normal knees.male (knee)/female (knee)= 47(53)/39(53),left/right=54/52.The CT scan (layer distance set at 0.75mm)was employed in the distal femur,The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the knee joint.The CT images of cross sections of the distal femur across lateral and medial femoral epicondyle were moved to personal computer,then measured CTA(angle between clinical transepicondylar axis and posterior condylar line),CSA(angle between clinical transepicondylar axis and surgical transepicondylar axis),using software of AutoCAD2007. When got the values,gave them a statistical analysis of gender and side with SPSS10.0.and compared statistically between with CTA and PCA,Angle PT,A-PA,constant 3°,the level of significance was p<0.05. And also analysed statistically A-PA and PCA,PCA and CTA,A-PA and CTA with the liner regression of SPSS10.0,and liner regression of SPSS10.0 were performed to assess the strength of the relationship between the axes of CTEA,STEA,PCL,APL及PLP. correlation coefficients(r)and coefficient of determination(R2) were calculated among the five axes. Results CTA:8.23°士1.40°(4.98°-11.44°),male 8.24°士1.39°,female 8.23°士1.48°,left 8.29°士1.44°,right 8.17°士1.36°.CSA:3.45°士0.68°(1.83°-5.40°),male 3.32°士0.62°,female 3.58°士0.72°;left 3.46°士0.66°,right 3.44°士0.71°.All the parameters have no difference between sex and side knees, but CSA have difference between male and female.there is difference between CAT and angle PT,PCA,A-PA,constant 3°.there is relativity between PCA and CTA(R2=0.87,P﹤0.001),and also PCA and A-PA(R2=0.58,P﹤0.001),CTA and A-PA(R2=0.56,P﹤0.001).there is significant relativity between STEA and CTEA(r=0.87,P﹤0.001),there is significant relativity between STEA and APL(r=0.58,P﹤0.001),there is significant relativity between STEA and PCL(r=0.53,P﹤0.001),and also have relativity between APLP,APL and PCL,but there is no significant relativity between PCL and CTEA(r=0.03,P=0.74). Conclusion The property is different entirely between STEAand CTEA, the rotational alignment is not performed according to paralleling to the CTEA in distal femur. Among surgical transepicondylar axis,Whiteside line,posterior condylar axis, the surgical transepicondylar axis is the most reliable mark of rotational alignment of the distal femur,and the posterior condylar axis is the less reliable mark.