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研究生:陳維廷
研究生(外文):Wei-Ting Chen
論文名稱:以磁振造影影像分析國人人工膝關節置換術切骨之基準
論文名稱(外文):Use of Magnetic Resonance Images to analyze the baseline of osteotomy of total knee arthroplasty in Chinese adults
指導教授:鄭誠功鄭誠功引用關係譚傳明譚傳明引用關係廖建忠廖建忠引用關係
指導教授(外文):Cheng-Kung ChengChuan-Ming TanJiann-Jong Liau
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫學工程研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:113
中文關鍵詞:人工膝關節置換手術股骨元件旋轉軸重建關節面參考點磁振造影影像
外文關鍵詞:Total Knee Arthroplasty(TKA)femoral component rotational axisjoint line restorationbony landmarkMagnetic Resonance Image
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人工膝關節置換手術(Total Knee Arthroplasty, TKA)中,關節元件定位和決定關節面(Joint line)的位置,對於手術成敗具有非常大的影響,因此找尋可信賴的參考點(bony landmark),來決定人工關節置換手術中切骨基準,即為重要的研究課題。先前研究顯示,國人膝關節幾何外形、尺寸略異於西方人,故其參考點亦不相同。然而目前參考點的相關研究都是以西方人為主,不適合用於國人。因此本研究目的為建立可信賴的國人膝關節參考點資料庫,希望可輔助醫師在首次置換手術(primary TKA)選擇股骨元件旋轉軸以及在再置換手術(revision TKA)重建病人原本的關節面有所幫助。
本研究利用118例膝關節骨頭正常成年國人的磁振造影影像(Magnetic Resonance Image),含男性75例,女性43例。運用醫學影像軟體進行測量,以三維的觀念測量各個參考點,並找出參考軸之間的關係與各參考點到關節面的距離,以建立國人膝關節參考點資料庫。
研究結果顯示,本研究突破以往用二維影像的測量來代表三維空間的距離及角度,避免以往因單張影像測量所造成的誤差。國人的股骨旋轉參考軸與西方人有所不同,股骨後側髁切線連線與手術型股骨內外上髁連線夾角是4.0°;解剖型股骨內外上髁連線與Whiteside’s line的夾角是88.9°。各參考點到關節面的距離也與西方人不同,股骨內髁凹穴、外上髁到遠端關節面的距離分別是25.7 mm、24.6 mm ; 股骨內髁凹穴、外上髁到後側關節面的距離分別是29.1 mm、
23.6 mm。腓骨頭尖端到關節面的距離為15.1 mm、脛骨粗隆最高點到關節面的距離為22.3 mm。我們建議醫師在首次置換手術時,參考我們的結果以正確的放置股骨元件。在再置換手術時,可以選用股骨外上髁來做為由股骨重建參考點的基準。也建議將來要用影像來進行參考點測量時,能夠用三維的方式測量避免產生誤差。
Component alignment and joint line restoration are very important for total knee arthroplasty(TKA). Therefore, using reliable bony landmarks to decide the baseline of osteotomy for TKA is an important issue. Previous studies revealed that Chinese adults have different geometry of knee joints from Caucasian’s. The database of bony landmark in literature consists primarily of Caucasian’s, which is not suitable for applying to Chinese. The purpose of this study is to establish the database of bony landmarks in Chinese adults for TKA, including some angles related to the femoral rotational axis in primary TKA and some distances related to the joint line in revision TKA.
This study analyzed MRI images of 118 normal Chinese knee joints (75 males and 43 females). We input the MRI data to the medical image software and use 3D concept to measure several bony landmarks to find the relationship of those bony landmarks. The distances between the bony landmarks and joint line are also measured.
The results of this study suggest that 3D conceptual measurement can reduce the errors from 2D images measurement. The database of bony landmarks for Chinese adults is different to Caucasian’s, the angle between surgical transepicondylar axis(TEA) and posterior condylar line is 4.0°, the angle between Clinical TEA and Whiteside’s line is 88.9°. The distance from medial sulcus to the distal joint line is 25.7 mm, the distance from lateral epicondyle to the distal joint line is 24.6 mm. The distance from medial sulcus to the posterior joint line is 29.1 mm, the distance from lateral epicondyle to the posterior joint line is 23.6 mm. The vertical distance from the fibular head tip to joint line is 15.1 mm. The vertical distance from tibial tubercle top to the joint line is 22.3 mm.
The data can be used for choosing the femoral component rotational axis in primary TKA. In revision TKA, we recommend to use lateral epicondyle as the major landmark to restore the joint line from femoral side.
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