زاويه كات ديستال فمور در بيماران تعويض مفصل زانوي با واروس شديد زانو متغير است (بررسي راديولوژيك)

Radiologic Assessment of Distal Femur Cutting Angle in Varus Knee Candidates for Total Knee Arthroplasty

ﺶ زﻣﻴﻨﻪ :اﻋﺎده در ﺟﺮاﺣﻲ ﺗﻌﻮﻳﺾ ﻣﻔﺼﻞ زاﻧﻮ ﺑﺮاي رﺳﻴﺪن ﺑﻪ ﻧﺘﻴﺠﻪ ﻣﻨﺎﺳﺐ 90 ي زاوﻳﻪ درﺟﻪ ﺑﻴﻦ ﺳﻄﺢ ﻣﻔﺼﻞ و ﻣﺤﻮر ﻣﻜﺎﻧﻴﻜﺎل ران ﻣﻮردﻧﻈﺮ ﻣﻲ ﺑﻪ ﺑﺎﺷﺪ و 5 ﻃﻮر ﻣﻌﻤﻮل ﺑﺮش اﻧﺘﻬﺎي ران ﺑﺎ زاوﻳﻪ در ﻣﻲ 7ﺟﻪ ﺗﻮﺳﻂ اﻛﺜﺮ ﺟﺮاﺣﺎن اﻧﺘﺨﺎب ﺷﻮد . در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮ روي ﺑﻴﻤﺎران ﻛﺎﻧﺪﻳﺪ ﺗﻌﻮﻳﺾ ﻣﻔﺼﻞ زاﻧﻮ ﺑﺎ دﻓﺮﻣﻴﺘﻲ واروس ﻣﺎ ﺑﺮاي ﭘﺎﺳﺦ ﺑﻪ اﻳﻦ ﺳﻮال ﺗﻼش ﻛﺮدﻳﻢ ﻛﻪ آ ﻳﺎ اﻳﻦ زاوﻳﻪ ﺑﺮش اﻧﺘﻬﺎي ران ﻳﻚ ﻃﻴﻒ ﺛﺎﺑﺖ اﺳﺖ ﻳﺎ ﺧﻴﺮ. ﻣﻮاد و روش ﻫﺎ : ﺳﺎل case series در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻛﻴﻔﻲ ﺳﻪ ﺳﺎﻟﻪ از 1394 اﺑﺘﺪاي 1396 ﺗﺎ اﻧﺘﻬﺎي 123 روي ﺑﻴﻤﺎر ﻛﺎﻧﺪﻳﺪ ﺗﻌﻮﻳﺾ ﻣﻔﺼﻞ زاﻧﻮ در ﺑﻴﻤﺎرﺳﺘﺎن ﻃﺎﻟﻘﺎﻧﻲ ﺗﻬﺮان ﺑﺎ دﻓﻮ (ران varus angle ) رﻣﻴﺘﻲ واروس زواﻳﺎي واروس اﻧﺪام bowing ) زاوﻳﻪ ﺧﻤﻴﺪﮔﻲ ، angle( (distal femoral cutting angle) زاوﻳﻪ ﺑﺮش اﻧﺘﻬﺎﻳﻲ اﺳﺘﺨﻮان ران ، زاوﻳﻪ ﺑﻴﻦ ﻣﺤﻮر ران ، NSA=neck ) ﮔﺮدن ران ﺑﺎ ﺷﻔﺖ (ﻣﻔﺼﻠﻲ shaft angle (اﻧﺪازه lateral distal femoral angle=LDFA) زاوﻳﻪ ﺑﻴﻦ ﻣﺤﻮر ﻣﻜﺎﻧﻴﻜﺎل ران و ﺧﻂ ، ﺷﺪﻧﺪ ﮔﻴﺮي . ﺟﻬﺖ ﺑﺮﺳﻲ آ SPSS ﻣﺎري از ﻧﺮم اﻓﺰار 20 ﺑﺎ ورژن اﺳﺘﻔﺎده ﺷﺪ و از ﺗﺴﺖآ ﺷﺪ tﻣﺎري ﻫﻢ ﺑﺮاي ﻣﻘﺎﻳﺴﻪ اﻃﻼﻋﺎت ﻗﺎﺑﻞ ﺷﻤﺎرش اﺳﺘﻔﺎده . ﻳﺎﻓﺘﻪ ﻫﺎ : 13.71 ±4.34 ﻣﺘﻮﺳﻂ زاوﻳﻪ واروس در ﻣﺮدان ﺑﻮد .ران 16.41±7.87 و در زﻧﺎن ﻣﺘﻮﺳﻂ زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل درﺟﻨﺲ ﻣﺬﻛﺮ 1.09±6.50 . ﺑﻮد7.38±1.75 و در ﺟﻨﺲ ﻣﻮﻧﺚ (%39) ﺑﻴﻤﺎر48در 5 زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران ﺧﺎرج از ﻣﺤﺪوده ﺑﻮد 7درﺟﻪ . ﺑﻴﻤﺎر32در )26 (% 7 اﻳﻦ زاوﻳﻪ ﺑﻴﻦ و 9درﺟﻪ ﺑﻮده (%6) ﺑﻴﻤﺎر8در ﺑﻮد 9 اﻳﻦ زاوﻳﻪ ﺑﻴﺸﺘﺮ از درﺟﻪ . 8در (%6)ﺑﻴﻤﺎر زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران ﻛﻤﺘﺮ از ﺑﻮد 5 درﺟﻪ .ﻗﺎﺑﻞ ﺗﻤﺎم زواﻳﺎ ﺑﺮاﺳﺎس ﺟﻨﺲ ﺗﻔﺎوت ﻧﺪاﺷﺘﻨﺪ ﺗﻮﺟﻪ ﺑﺎ ﻫﻢ .ﻣﻌﻨﻲ ارﺗﺒﺎط دار ﺧﻮﺑﻲ ﺑﻴﻦ زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران ﺑﺎ زاوﻳﻪ (r= 0.769) ﺧﻤﻴﺪﮔﻲ ران وﺟﻮد داﺷﺖ ﺑﻮد NSA ﻫﻤﭽﻨﻴﻦ ارﺗﺒﺎط زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران ﺑﺎ زاوﻳﻪ .(r=0.523) ﻣﺘﻮﺳﻂ ارﺗﺒﺎط زاوﻳﻪ (r=0.11) ﺑﻮدهLDFA ﺑﺮش دﻳﺴﺘﺎل ران و ﺑﻮد LDFA و ارﺗﺒﺎط زاوﻳﻪ واروس و (r= 0.28) ﭘﺎﻳﻴﻦ LDFAﻫﻤﭽﻨﻴﻦ NSA ﺑﺎ زاوﻳﻪ ارﺗﺒﺎط (ﻳﺎﻓﺘﻪ r=0.15) داﺷﺘﻨﺪ ﺑﺮاﺳﺎس دﻳﺴﺘ زاوﻳﻪ ﺑﺮش ، ﻫﺎي ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﺎل ران در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﻧﻴﺎز ﺑﻪ ﺗﻌﻮﻳﺾ ﻣﻔﺼﻞ زاﻧﻮ داﺷﺘﻪ و دﻓﻮرﻣﻴﺘﻲ ﺑﺎﺷﺪ 7 واروس دارﻧﺪ ﻣﻤﻜﻦ اﺳﺖ ﺑﻴﺸﺘﺮ از درﺟﻪ . ﻧﺘﻴﺠﻪ ﮔﻴﺮي : 7 زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران در ﺗﻌﻮﻳﺾ ﻣﻔﺼﻞ زاﻧﻮ ﺑﻴﻤﺎران ﺑﺎ واروس ﺷﺪﻳﺪ ﻋﺪد ﺛﺎﺑﺘﻲ ﻧﺪاﺷﺘﻪ و ﻣﻤﻜﻦ اﺳﺖ ﺑﻴﺸﺘﺮ از درﺟﻪ ﺑﺎﺷﺪ . ﺑﻪ ﻫﻤﻴﻦ دﻟﻴﻞ در اﻳﻦ ﮔﺮوه ﻣﭻ از ﺑﻴﻤﺎران ﺑﻬﺘﺮ اﺳﺖ رادﻳﻮﮔﺮاﻓﻲ اﻳﺴﺘﺎده از ﻟﮕﻦ ﺗﺎ ﭘﺎ ﮔﺮﻓﺘﻪ ﺷﺪه و زاوﻳﻪ ﺑﻴﻦ ﻣﺤﻮر ﻣﻜﺎﻧﻴﻜﺎل ران ﺑﺎ ﻣﺤﻮر آ ﺷﻮد ﻧﺎﺗﻮﻣﻴﻜﺎل ران در ﻳﻚ ﺳﻮم دﻳﺴﺘﺎل ﺗﻌﻴﻴﻦ .ﻳﺎﻓﺘﻪ ﺑﺮاﺳﺎس ﻫﺎي ﻣﻄﺎﻟﻌﻪ ﻣﺎ اﮔﺮ زاوﻳﻪ ﺧﻤﻴﺪﮔﻲ ران ﻧﻴﺰ زﻳﺎد ﺑﺎﺷﺪ زاوﻳﻪ ﺑﺮش دﻳﺴﺘﺎل ران ﻧﻴﺰ ﺑﻴﺸﺘﺮ ﺧﻮاﻫﺪ ﺷﺪ.

Background: In a total knee arthroplasty surgery the goal is to produce 90 degree angle between the knee articular lobe and the mechanical femoral line. Most orthopedic surgeons usually utilize a 5 to 7 degree for distal femoral cutting angle. In this study we will aim at clearing this question, that whether the” five-seven degree” distal femoral cutting angle supposed to be an equable spectrum? Method: In this three year course of study, 123 candidate patients for knee arthroplasty with varus knee deformities underwent pre operatore radiologic assessment before joint replacement surgery. The femoral bowing angle, distal femoral cutting angle, neck shaft angle, angle between knee articular line and mechanical femoral angle were assessed and statistically analyzed. Results: The mean varus angle was in 13.71±4.34 in male and 16.41±7.87 in female. The mean distal femoral cutting angle (DFCA) was 6.50±1.09 in male and 7.38±1.75 in female. In 48 patients (%39) the female DFCA was out of 507 degree range. In 32 (26%) of patients the DFCA was 7-9 degrees and in 8 (%6) it was over 9 degrees, and in 8 (%6) was less than 5. The angle differences had no sex-related variation. There was a good co-relation between DFCA and bowing angle (r=0.769). The co-relation between DFCA and NSA was moderator (r=0.523). The co-relation between DFCA and DFA (r=0.11) and varus angle with LDFA (r=0.28) was low. LDFA was also related to NSA (r=0.15). Therefore, the candidates for knee replacement who have varus deformity may need a distal femoral cutting angle over 7 degrees. Based on these results, the distal femoral cutting angle in patients in need of a knee arthroplasty and varus deformity might be more than seven degrees. Conclusion: The distul femoral cutting angle in knee arthroplasty in face of severe varus does not have a constant value and maybe over 7 degrees. A long standing radiograph is needed to measure the mechanical and correlate with axis the anatomic axis of distal third of femur. When the bowing angle is high the DFCA will need to be higher.