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단순 방사선 촬영을 이용한 인공슬관절 전치환술전 하지축 계측의 표준화에 대한 고찰
김종관,안택진,안병우,박찬협 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.2
Long term success after total knee arthroplasty(T.K.P.) is dependent on several factors, especially proper intraoperative component positioning. Numerous TKR alignment systems including intramedullary and extramedullary instruments are considered by many authors to be reliable methods of producing proper component positioning. Standardization of preoperative radiograghy for TKR is essential to getting appropriate axial alignment after components positioning. So, we made AP and lateral radiograghs of entire lower extremity with the voluteer standing and included not only intraoperative femur A-P and lateral films into this study, but also A-P and lateral radiograhgs of 40 cadaveric femoral skeletons. Analysis of those radiograhgs led us to the following results. 1. The volunteer is positioned with both posterior condylar surfaees at the same level (neutral rotation). In neutral rotation, the line crossing bimalleolor tips is rotated average 24.6±2.6degrees extemally. 2. On A-P radiogragh, the knee center is a point on the apex of the femoral notch on A-P radiograph and on the center of stem of femoral prosthesis template is positioned in place after sizing on the lateral film. 3. Mechanical axis crosses knee center and the center of femoral head either on A-P radiograph or on lateral film. 4. Anatomical axis crosses the apex of femoral notch and the center between inner cortex surface of the femoral isthmus on AP radiograph. On lateral radiograph, anatomic axis crosses a point 4mm anterior to posterior cortical inner surface paralleling the mechanical axis. 5. Entry point of intramedully rod is a point that is about 8.2mm±1.9mm anterior to the border of femoral intercondylar notch through which the anatomic axis crosses distal knee surface on lateral film.