Slot 双下肢全长摄影在全膝关节置换术中的应用价值

Application value of Slot-radiography of whole lower extremities in total knee arthroplasty

摘要:

目的 探讨动态平板透视的狭缝全景摄影技术（Slot）双下肢全长摄影在膝关节置换术的临床应 用价值。方法 回顾性分析2013 年11 月-2017 年3 月89 例膝关节置换患者，共99 个膝关节进行全膝关节置 换术，每位患者在手术前后分别使用动态平板透视摄影系统的狭缝全景技术进行负重位的双下肢全长摄影， 采用0 ～ 2 分的评分方式对图像质量进行评估，0 分图像质量差，1 分图像质量中等，2 分者为图像质量优良， 并在图像质量优良的图片上通过后处理软件对患者的手术膝进行术前和术后下肢力线及胫股角进行测量，对 术前进行全面评估，同时通过对比分析评价手术效果。结果 ① 89 例患者Slot 双下肢全长摄像一次成功率 100%，成像时间短，操作简便、快捷，每位患者图像质量评分均为2 分，质量优良，完全满足诊断及临床的要求； ② 89 例患者术前均得到全面准确的评估，80 例为骨性关节炎，9 例为创伤性骨关节炎，其中，合并膝内翻畸 形17 例，膝外翻畸形患者8 例，无合并内外翻畸形者64 例；③术后所有患者假体对位、对线良好，假体周围 无骨折，所有患者下肢力线和胫股角均为正常范围，17 例膝关节内翻畸形患者，胫股角手术前后比较差异有 统计学意义（t =-6.590，P =0.000）；8 例膝外翻畸形患者，胫股角手术前后比较差异有统计学意义（t =5.597， P =0.001），膝内外翻畸形较术前均得到良好的校正；无合并内外翻畸形64 例患者术后下肢力线与重力垂线 夹角和胫股角与手术前后比较，差异无统计学意义（t 前者=0.725，P =0.487，t 后者=-2.090，P =0.070）。结论 使 用狭缝全景摄影技术对双下肢全长进行成像，其成功率高、检查时间短、辐射剂量低，且图像拼接操作简便， 质量优良，满足临床诊断需求，对临床术前手术方案制定及术后评估具有重要应用价值。

Abstract:

Objective To investigate the clinical application value of Slot of dynamic flat-panel X-ray photography system of whole lower extremities in total knee arthroplasty. Methods From November 2013 to March 2017, a retrospective analysis was made that a total of 89 total knee arthroplasty patients,which were 99 knee joints, received the radiography of whole lower extremities in standing position by slot of dynamic flat-panel X-ray photography system pre-and post-surgery, respectively. Score manner (0 - 2 marks) was used to evaluate the image quality. The lower limb alignment and femorotibial angle of patients' surgery knee were measured with the post-processing software. All knees were evaluated completely before surgery and the surgery effect was evaluated by comparing X-ray findings pre- and post-surgery. Results (1) All the 89 patients with the slot examinationhad a success rate of 100% with short imaging time, simple and convenient surgery, high quality images (mark 2), which completely met diagnostic and clinical requirements. (2) All the patients with Genuv arum (n = 17), genuvalgum (n = 8) and no Genu varum or valgum (n = 64) were fully and accurately evaluated before surgery. The surgery effects for all 89 patients were good, and 25 patients of genu varum or valgum has been corrected well. (3) All patients' prosthesis have good alignment, without fracture around the prosthesis. The lower limb line and femorotibial angle (FTA) were allin normal reference range. Compared with the pre-surgery ones, the FTA in 17 cases with varus knee deformity was statistically significant (t = -6.59, P < 0.001); in 8 cases of valgus knee deformity, the difference of FTA was statistically significant (t =5.597, P < 0.05), the varus and valgus deformity of knee was corrected better than pre-surgery; there were no statistically significant differences for the angle between lower limb line and gravity of vertical and the angle between lower limb line and FTA between pre- and post-surgery (tpre = 0.725, P = 0.487, and tpost =-2.09, P = 0.07, respectively). Conclusions Slot radiography of whole lower extremities has high success rate, fast acquisition and low radiation dose. It is also with simple image stitching performance and excellent quality images, which meets the needs of clinical diagnosis and is of important value for preoperative planning and postoperative evaluation.