胫骨后倾角的测量及与后交叉韧带生物力学关系的研究进展
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作者Author单位AddressE-Mail
肖娟 XIAO Juan 湖北中医药大学附属襄阳市中医医院, 湖北 襄阳 441000 Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine, Xiangyang 441000, Hubei, China  
皮红林 PI Hong-lin 湖北中医药大学附属襄阳市中医医院, 湖北 襄阳 441000 Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine, Xiangyang 441000, Hubei, China hbspine@126.com 
余志勇 YU Zhi-yong 湖北中医药大学附属襄阳市中医医院, 湖北 襄阳 441000 Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine, Xiangyang 441000, Hubei, China  
王翰宇 WANG Han-yu 湖北中医药大学附属襄阳市中医医院, 湖北 襄阳 441000 Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine, Xiangyang 441000, Hubei, China  
汪黎 WANG Li 湖北中医药大学附属襄阳市中医医院, 湖北 襄阳 441000 Xiangyang Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Traditional Chinese Medicine, Xiangyang 441000, Hubei, China  
期刊信息:《中国骨伤》2022年,第35卷,第9期,第898-902页
DOI:10.12200/j.issn.1003-0034.2022.09.019
基金项目:
中文摘要:胫骨后倾角(tibial posterior slope,TPS)最可靠最便捷的测量方式及与后交叉韧带(posterior cruciate ligament,PCL)的生物力学关系存在较大争议。使用X线测量时,推荐使用下肢全长侧位X线片4等份法,其具有高度的可重复性及在日常诊疗过程的普遍性,但仅仅适用于胫骨旋转在15°以内的患者,当旋转超过30°时,平台内侧轮廓不好辨认,不再适用;若仅仅用于日常诊疗评估,当胫骨旋转角在15°以内时,膝关节侧位X线片也具有一定的参考意义,但精准度不能满足要求较高的临床研究。CT测量方法虽能纠正胫骨旋转,但利用在三维CT重建上放置拟合点来测量的方法只适用于无关节退变的膝关节,较多的骨赘会影响利用拟合点的方式来确定的胫骨平面与真实胫骨平台的符合度,具有一定的局限性。MRI不仅可以纠正胫骨旋转,而且使用胫骨解剖轴作为参考轴可以最大程度减少骨赘的影响从而测量出TPS,是一种较好的测量方式。TPS与PCL的生物力学关系,在胫骨截骨术中增大的TPS通过胫骨前移位间接减轻PCL的张力或直接减轻对PCL的负荷都提示可对其产生保护机制;在保留交叉韧带的全膝关节置换术中,TPS的大小会影响股骨的回旋机制,当患膝存在PCL损伤时,应避免对其进行松解以免加重损伤,可通过适当增加TPS的方式减轻其应力;最有益于保护PCL的TPS范围尚无统一结论,7°~10°被较多学者推荐为最有益于保护PCL的范围,但仍需根据患者骨质状态、手术方式等差异进行进一步研究。
【关键词】胫骨  后交叉韧带  生物力学现象  综述
 
Progress on measurement of tibial posterior slope and its biomechanical relationship with posterior cruciate ligament
ABSTRACT  The most reliable and convenient measurement method of tibial posterior slope (TPS) and its biomechanical relationship with posterior cruciate ligament (PCL) are still controversial.For X-ray measurement,it is recommended to use full-length lateral X-ray of the lower extremity in quatrous section,which has advantage of highly repeatable and common in the daily diagnosis and treatment process,but it is only applicable to patients with tibial rotation within 15°.When the rotation exceeds 30°,it is difficult to identify the inner contour of platform and is no applicable.If it is only used for daily diagnosis and treatment evaluation,when tibial rotation angle is less than 15°,lateral knee X-ray also has a certain reference significance,but the accuracy could not meet requirements of higher clinical research.For CT measurement method,it could correct tibial rotation,but using the fitting point to measure tibial posterior slope on three-dimensional CT reconstruction is only applicable to knee joint without degeneration,more osteophyte affects the way of using fitting point to determine the plane of tibia with real tibia platform conformity degree,have some limitations.For measurement of MRI,it could not only correct tibial rotation,but also minimize the effect of osteophytes by using tibial anatomical axis as the reference axis,which is a good measurement method.For the biomechanical relationship between tibial posterior slope and tibial posterior slope,increased tibial posterior slope indirectly alleviates tension of PCL through tibial anterior displacement or directly reduces load on posterior cruciate ligament in tibial osteotomies,suggesting a protective mechanism for tibial posterior slope;in total knee arthroplasty with cruciate ligament preserved,the size of tibial posterior slope will affect roll back mechanism of femur.When affected knee with PCL injury,it should be avoid to release then aggravate injury,and the stress could be alleviated by increasing tibial posterior slope appropriately.There has been no unified conclusion on the range of tibial posterior slope that is most beneficial to PCL.The natural tibial posterior slope is between 7 ° and 10°,which is considered to be the most beneficial to protection of PCL,but further studies are needed according to the differences in patients'bone status,surgical methods and so on.
KEY WORDS  Tibia  Posterior cruciate ligament  Biomechanical phenomena  Review
 
引用本文,请按以下格式著录参考文献:
中文格式:肖娟,皮红林,余志勇,王翰宇,汪黎.胫骨后倾角的测量及与后交叉韧带生物力学关系的研究进展[J].中国骨伤,2022,35(9):898~902
英文格式:XIAO Juan,PI Hong-lin,YU Zhi-yong,WANG Han-yu,WANG Li.Progress on measurement of tibial posterior slope and its biomechanical relationship with posterior cruciate ligament[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(9):898~902
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