Objective: To measure and analyze the anatomical parameters of the femur by measuring and analyzing the positive and lateral X-ray films of the full-length weight-bearing lower limbs and the three-dimensional model of the femur CT, and to clarify the correlation between the anatomical morphology of the femur and the sagittal force line, so as to provide help for the placement of knee prosthesis and the accurate recovery of the lower limb force line in total knee arthroplasty. Methods: Ten healthy volunteers were recruited. The full-length X-ray films of the lower limbs were taken to determine the coronal and sagittal force lines of the lower limbs and the weight-bearing ratio. The imaging data of 60 patients with full-length CTA of both lower limbs were collected. The CT data were reconstructed by Mimics software. The relevant anatomical parameters were measured by combining two-dimensional images and three-dimensional reconstruction models. The data were analyzed by K-S test. Results: (1)The standard weight-bearing positive bearing axis is located at 45% of the medial femoral condyle, and the lateral bearing axis is located at 44% before the transverse axis of the femoral condyle. (2) The femoral three-dimensional model measured femoral valgus angle, femoral lateral arch angle, femoral anterior arch angle, proximal femoral eccentricity, femoral neck anteversion, femoral neck shaft angle, and femoral length were 4.55°±1.31°, 0.41°±1.44°, 9.54°±1.57°, 37.04±4.74 mm, 14.99° ±7.52°, 131.17±7.23 °, and 414.24±23.70 mm, respectively; the angles between the femoral anatomical axis and the coronal and sagittal planes were 8.60±1.45, 0.75±0.60, 1.05±0.70 and 0.61±0.50, respectively; the angles between the femoral force line and the coronal and sagittal planes were 1.38°±0.93° and 4.77°±1.65°, respectively. (3)Correlation analysis showed that the femoral valgus angle was positively correlated with the femoral lateral arch angle (r=0.552, P＜0.001), the femoral valgus angle was positively correlated with the proximal femoral eccentricity (r=0.502, P＜0.001), and the femoral anterior arch angle was positively correlated with the femoral neck anteversion angle (r=0.543, P＜0.001); the angle between the femoral force line and the sagittal plane was positively correlated with the femoral anterior arch angle (r=0.823, P＜0.001), and the angle between the femoral force line and the sagittal plane was positively correlated with the femoral neck anteversion angle (r=0.424, P＜0.001). Conclusion: The angle between the femoral force line and the sagittal plane is closely related to the femoral anterior arch angle and the femoral neck anteversion angle. Therefore, if the femoral anterior arch angle and the femoral neck anteversion angle are larger before operation, the osteotomy angle should be adjusted accordingly, which is conducive to achieving a more reasonable alignment of the force line. The correlation between the anatomical morphology of the femur and the sagittal alignment of the femur described in this study has important reference significance for the placement of knee prosthesis and total knee arthroplasty.
ZHAO Anquan
,
QI Yansong
,
XU Yongsheng
,
Baohuricha
. Correlation between femoral anatomical morphology and sagittal force line based on X-ray and CT three-dimensional reconstruction[J]. Journal of Baotou Medical College, 2024
, 40(4)
: 20
-26
.
DOI: 10.16833/j.cnki.jbmc.2024.04.004
[1] Klein GR, Parvizi J, Rapuri VR, et al. The effect of tibial polyethylene insert design on range of motion[J]. J Arthroplasty, 2004,19(8):986-991.
[2] Tang WM, Chiu KY, Kwan MF, et al. Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty[J]. J Orthop Res, 2005,23(1):41-45.
[3] Rossi R, Cottino U, Bruzzone M, et al. Total knee arthroplasty in the varus knee: tips and tricks[J]. InternationalOrthopaedics (SICOT), 2019,43(1):151-158.
[4] Bonutti PM, Dethmers D, Ulrich SD, et al. Computer navigation-assisted versus minimally invasive TKA[J]. Clin Orthop Relat Res, 2008,466(11):2756-2762.
[5] Matsumoto T, Hashimura M, Takayama K, et al. A radiographic analysis of alignment of the lower extremities–initiation and progression of varus-type knee osteoarthritis[J]. Osteoarthr Cartil, 2015,23(2):217-223.
[6] Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who issatisfied and who is not?[J]. Clin Orthop Relat Res, 2010,468(1):57-63.
[7] Wylde V, Learmonth I, Potter A, et al. Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement[J]. J Bone Joint Surg Br, 2008,90(9):1172-1179.
[8] Sugama R, Minoda Y, Kobayashi A, et al. Sagittal alignment of the lower extremity while standing in female[J]. Knee Surg Sports Traumatol Arthrosc, 2011,19(1):74-79.
[9] Minoda Y, Kobayashi A, Iwaki H, et al. Sagittal alignment of the lower extremity while standing in Japanese male[J]. Arch Orthop Trauma Surg, 2008,128(4):435-442.
[10] 左建林,柳林,应洪亮,等. 基于三维CT多平面重建股骨近段髓腔的形态学实验[J]. 中国组织工程研究与临床康复,2010,14(22):4005-4009.
[11] Swanson KE, Stocks GW, Warren PD, et al. Does axial limb rotation affect the alignment measurements in deformed limbs?[J]. Clin Orthop Relat Res, 2000(371):246-252.
[12] 李超,程静波,冯明利. 从生物力学角度认识股骨解剖结构对膝关节置换的影响[J]. 中国组织工程研究, 2020,24(36):5850-5857.
[13] Rivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: A systematic review[J]. Orthop Traumatol Surg Res, 2017,103(7):1047-1056.
[14] Chen X, Chen X, Zhang G, et al. Accurate fixation of plates and screws for the treatment of acetabular fractures using 3D-printed guiding templates: an experimental study[J]. Injury, 2017,48(6):1147-1154.
[15] Jiang CC, Insall JN. Effect of rotation on the axial alignment of the femur. Pitfalls in the use of femoral intramedullary guides in total knee arthroplasty[J]. Clin Orthop Relat Res, 1989(248):50-56.
[16] Brouwer RW, Jakma TS, Brouwer KH, et al. Pitfalls in determining knee alignment: a radiographic cadaver study[J]. J Knee Surg, 2007,20(3):210-215.
[17] Lee JH, Wang SI. Risk of anterior femoral notching in navigated total knee arthroplasty[J]. Clin Orthop Surg, 2015,7(2):217-224.
[18] Tang WM, Chiu KY. Variances in sagittal femoral shaft bowing in patients undergoing TKA[J]. Clin Orthop Relat Res, 2008,466(4):1008-1009.
[19] Zalzal P, Backstein D, Gross AE, et al. Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses[J]. J Arthroplasty, 2006,21(5):737-743.
[20] Nam JH, Koh YG, Kim PS, et al. Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging[J]. Surg Radiol Anat, 2020,42(10):1231-1236.
