背景:已经报道了大量股骨髁矢状形态的解剖变异,在球形(或单半径)和卵形(或多半径)髁之间具有连续体。本系统综述和荟萃分析的目的是批判性地评估和综合有关矢状股骨轮廓的现有文献。假设是,研究将揭示个体之间相当大的差异,而且在他们量化矢状轮廓的方法中。
方法:本系统评价按照系统评价和荟萃分析(PRISMA)指南的首选报告项目进行。2021年9月10日,两位作者使用MEDLINE®搜索了I至IV级研究,这些研究报告了股骨内侧和/或外侧髁的矢状曲率。EMBASE®和Cochrane图书馆。结果以表格方式汇总,报告的曲率半径的标准偏差和/或范围,或椭圆体的半大和半小长度的髁。为了量化矢状面的“Ovoidicity”和不对称性,结果根据坐标参考框架(后髁轴(PCA),临床和外科经上髁轴(cTEA和sTEA),统一矢状面(USP),或不清楚),并在森林地块中总结为标准化平均差异(SMD)。
结果:38篇文章符合全文抽取条件,通过最佳拟合圆(BFC)量化矢状曲率半径,椭圆体,多项式,球形或圆柱形配件。对测量平面有明确定义的研究表明,两个髁通常都是卵圆形的,在内侧髁处具有相当大的“卵性”(SMD,4.09)与外侧髁(SMD,3.33).此外,当与TEA正常测量时,髁突远端半径内侧更大(cTEA:SMD,0.81;sTEA:SMD,0.79),但在USP中测量时横向更大(SMD,-0.83)。在USP中测量时,后髁半径横向更大(SMD,-0.60)。
结论:研究报告了股骨髁的矢状曲率半径的相当大的变异性,它们不是增量的,而是一个从球形到卵形的连续体。虽然这种变化可以通过单一的,双半径和多半径股骨组件,外科医生通常仅使用一个或两个TKA设计。因此,天然矢状面和假体矢状面之间存在不匹配的风险,这可能导致中屈曲韧带失衡,除非改变其他参数.这些发现支持了对患者特定植入物的驱动,以通过植入物定制实现准确的矢状骨-植入物配合。
方法:IV.
BACKGROUND: Considerable anatomic variations of sagittal femoral condylar shape have been reported, with a continuum between spherical (or single-radius) and ovoid (or multi-radius) condyles. The purpose of this systematic
review and meta-analysis was to critically appraise and synthesise the available literature on the sagittal femoral profile. The hypothesis was that studies would reveal considerable variability among individuals, but also in their methodology to quantify sagittal profiles.
METHODS: This systematic
review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. On 10 September 2021 two authors searched for Level I to IV studies that reported on the sagittal curvature of the medial and/or lateral femoral condyles using the MEDLINE®, EMBASE® and Cochrane Library. Results were summarised by tabulating means, standard deviations and/or ranges for the reported radii-of-curvature, or ellipsoidal semi-major and semi-minor lengths of the condyles. To quantify sagittal \'ovoidicity\' and asymmetry, results were stratified according to coordinate reference frame (posterior condylar axis (PCA), clinical and surgical transepicondylar axis (cTEA and sTEA), unified sagittal plane (USP), or unclear) and summarised in forest plots as standardised mean differences (SMD).
RESULTS: Thirty-eight articles were eligible for full text extraction, quantifying sagittal radii-of-curvature by best-fit circles (BFC), ellipsoids, polynomials, spherical or cylindrical fitting. Studies with clear definition of the measurement plane revealed that both condyles were generally ovoid, with considerably greater \'ovoidicity\' at the medial condyle (SMD, 4.09) versus the lateral condyle (SMD, 3.33). In addition, distal condylar radii were greater medially when measured normal to the TEA (cTEA: SMD, 0.81; sTEA: SMD, 0.79), but greater laterally when measured in a USP (SMD, - 0.83). Posterior condylar radii were greater laterally when measured in a USP (SMD, - 0.60).
CONCLUSIONS: Studies reported considerable variability of sagittal femoral condylar radii-of-curvature, which are not incremental, but rather a continuum that ranges from spherical to ovoid. Although this variation could be accommodated by single-, dual- and multi-radii femoral components, a surgeon typically uses only one or two TKA designs. Hence, there is a risk of mismatch between the native and prosthetic sagittal profile that could result in mid-flexion ligament imbalance unless other parameters are changed. These findings support the drive towards patient-specific implants to potentially achieve accurate sagittal bone-implant fit through implant customisation.
METHODS: IV.