- 著者
- 川島 史義 髙木 博 古屋 貴之 加藤 慎 佐藤 敦 前川 勝彦 浅井 聡司 中田 規之
- 出版者
- 日本関節病学会
- 雑誌
- 日本関節病学会誌 (ISSN:18832873)
- 巻号頁・発行日
- vol.36, no.1, pp.15-19, 2017 (Released:2018-03-31)
- 参考文献数
- 10
Introduction: Several methods have been proposed to determine proper femoral component rotation alignment in total knee arthroplasty (TKA). Usually the epicondylar axis, the posterior condylar axis and Whiteside’s line are used for landmarks. However, sometimes recognition of these landmarks is difficult intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view via a preoperative radiograph. The angle consists of the clinical epicondylar axis (CEA) and the posterior condyle line minus two degrees. We think the influence of the residual cartilage of the posterior lateral femoral condyle is about two degrees in varus osteoarthritis (OA).Objective: The objective of this study was to evaluate the rotation alignment of the femoral component after TKA, and the usefulness of our method for the decision of femoral component rotation alignment.Methods: There were 43 patients (7 males, 36 females) with varus OA who underwent primary TKA. The average age was 78.1 years (range, 64-87 years). The rotation angle of the femoral component was decided by the above-mentioned method. We evaluated the angle between the posterior border of the femoral component and the CEA, and the surgical epicondular axis (SEA) using postoperative computed tomography. These angles were expressed as∠CEA and∠SEA. External rotation was expressed as plus.Results: The mean∠CEA was−1.1 (−5-1)°. The mean∠SEA was 0.48 (−3-3)°. The mean angle of∠SEA−∠CEA was 1.5 (0-3)°. The femoral component was placed in internal rotation to CEA and parallel to SEA.Conclusion: Internal placement of the femoral component was considered to be caused abnormal patella tracking and dislocation and low value of Knee Society Knee scoring. We think that it can be difficult to recognize some landmarks intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view of preoperative radiographs. From the results of this study, the femoral component was placed in internal rotation to CEA and parallel to SEA. We conclude that our method for the decision of the femoral component rotation alignment is useful for TKA of varus OA of the knee.
は じ め に 変形性膝関節症(膝OA)に対する治療として,初期には食事療法,運動療法,薬物療法などの保存的治療が行われるが,それでもなお人工膝関節全置換術(TKA)に代表される手術的治療が必要となる症例も多く増加傾向である.近年,慢性疼痛に対する新規薬剤が導入され,その一つであるデュロキセチンの効果も報告されている.また,慢性疼痛を有する膝OAに対するデュロキセチンの有用性も確立されてきている.しかし,TKA周術期におけるデュロキセチンの効果に関する報告は少ない.そこでわれわれは,慢性疼痛を有する膝OA 11例に対しTKA周術期にデュロキセチンを使用し,その術後鎮痛効果を検討したので文献的考察を加え報告する.