인공 슬관절 전치환술 시 적절한 대퇴 치환물의 회전 정렬을 위한 원위 대퇴골과 경골의 해부학적 고찰
Anatomical Assessment of the Distal Femur and Tibia for Optimal Femoral Rotational Alignment in Total Knee Arthroplasty
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목적: 본 연구는 1) 인공 슬관절 전치환술 시 균형잡힌 90o 굴곡 간격을 위한 대퇴 회전 정렬의 축과, 2) 90o와 130o 굴곡에서의 굴곡 간격 사이의 변화 및 3) posterior condylar axis (PCA) 이용 시 후방 대퇴과의 비 대칭적 연골 소실에 의한 대퇴 회전 정렬의 변화를 알아보고자 하였다. 대상 및 방법: 건강한 성인 40명의 원위 대퇴골의 축상면 자기공명영상과 90o 굴곡 및 130o 굴곡 위에서의 원위 대퇴골과 경골 전장의 관상면 자기공명영상을 이용, 분석하였다. 결과: 임상적 transepicondylar axis (TEA)가 평균적으로 균형 잡힌 90도 굴곡 간격을 얻을 수 있는 축이었으며, 90o에서 균형잡힌 굴곡 간격은 130o에서는 내측 구획이 외측 구획에 비하여 상대적으로 좁아지는 비대칭적인 간격이 되었다. PCA를 이용한 회전 정렬은 양측 후방 대퇴과의 비대칭적 연골 소실 1 mm당 약 1o의 변화가 생겼다. 결론: 임상적 TEA는 균형 잡힌 굴곡 간격을 얻는데 유리한 대퇴 회전 정렬 축임을 시사하며, PCA를 이용하여 대퇴 치환물의 회전 정렬을 정할 때 내, 외측 구획의 연골 소실 상태의 차이에 따라 회전 정렬이 변할 수 있음을 고려해야 한다.
Abstract
Purpose: This study aimed 1) to identify the rotational axis of the femur that provides a balanced 90o flexion space in TKA, 2) to assess the changes in the flexion space in deep flexion, and 3) to assess the changes in rotational alignment, with using the posterior condylar axis (PCA) as a guide, and as the changes are related to asymmetric cartilage erosion of the posterior condyle. Materials and Methods: The axial MR images of the distal femur in knee extension and the coronal images of the distal femur and the entire tibia at 90 and 130o were examined in 40 healthy adults. Results: The clinical transepicondylar axis (TEA) provides a balanced 90o flexion space on average. The balanced flexion space in 90o became an asymmetrical space with relative narrowing of the medial side in 130o. Every 1 mm of asymmetrical cartilage erosion between the posterior condyles changed the femoral rotation by approximately 1o when using the PCA as a guide. Conclusion: This study suggests that the clinical TEA is the rotational reference that provides a balanced flexion space. When using the PCA as a rotational reference, a surgeon should consider the potential change in the rotational angle that is caused by asymmetrical cartilage erosion.
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