膝关节前参考和后参考区别
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来源：关节置换助手
前参考：以股骨前皮质为参考，前方截骨位置恒定，后髁截骨厚度发生变化。
避免前方皮质多切èNotching，更好重建髌骨关节间隙。
后方切除可变性，注意调节屈曲间隙，避免屈曲过紧。
宁小勿大：避免屈曲过紧，减少活动度。
后参考：以股骨后髁为参照，后髁截骨厚度恒定，前方截骨厚度发生变化。
优点：屈曲间隙可等于伸直间隙。
缺点：前侧皮质容易多切。
假体太小è前方Notching。
假体太大è髌股关节过紧。
对线：股骨、胫骨截骨面均垂直于各自的机械轴，负荷才能均匀分布。
屈曲间隙：
股骨尺寸可影响。
股骨假体安放的前后位置可影响。
前参考可避免假体安放过前，造成髌股并发症。
后参考可避免后髁不多切，精确重建关节线。
股骨对线：
胫骨对线：
7度的后倾：实现后滚，提供更多负荷承载量。
附一（中英对照）：
股骨前髁解剖的性别差异
Differences Between the Sexes in theAnatomy of the Anterior Condyle of the Knee
By Thomas K. Fehring, MD, Susan M. Odum, MEd, CCRC, Josh Hughes,BS, Bryan D. Springer, MD,
and Walter B. Beaver Jr., MD
Investigation performed at the OrthoCarolina Hip and KneeCenter, Charlotte, North Carolina
背景：有文章称膝前髁的解剖有非常大的性别差异，因此在设计全膝关节假体时前髁更窄专门为女性患者使用。我们观察到，在我们的病例当中，前髁解剖的差异非常大，差异取决于患者尺寸，高度，种族和性别。因为这些可以看到的不同，我们试图确定是否存在前髁解剖的性别差异。
【原文】
Background: Claimsthat there are dramatic differences in anterior condylar anatomy between thesexes have led to the design of total knee implants with thinner anteriorcondyles specifically for use in women. We had observed, in ourpatients, differences in anterior condylar anatomy that appeared to be highlyvariable and dependent on the size, height, and ethnicity of thepatient as well as his or her sex. Because of this observed variability, we soughtto determine if differences in anterior condylar anatomy between the sexesactually exist.
方法：我们评估了212名随机患者的核磁共振图像（112名男性，100名女性）。膝盖前髁的定义是股骨前皮质的前方骨性区域，位于关节线上10mm。前髁内侧和外侧的高度以毫米为单位，数据直接通过两个位面的核磁共振数据测定。计算纵横比来确定患者的尺寸是否影响前髁的尺寸。
【原文】
Methods: Twohundred and twelve randomly selected magnetic resonance images (112 of men and100 of women) were evaluated. The anterior condylewas defined as the area of bone anterior to the anteriorfemoral cortex, 10 mm above the joint line.The medial and lateral heights of the anteriorcondyles were measured in millimeters directly from magnetic resonance imagingdata obtained in two planes. Theso-called aspect ratio was calculated to determine whether patient size had aneffect on the size of the anterior condyles.
结果：在现有病例的基础上，两性之间在外侧髁的高度上并没有显著差异（p=0.16）。平均差异仅为0.5mm。男性和女性的内侧髁高度有显著差异（p=0.001）。然而，平均差异仅为1.1mm。尽管两性之间前髁高度的差异只是名义上的，无论性别测量结果差异很大。根据现有的病例，男性与女性之间髁的纵横比没有显著差异。
【原文】
Results: On thebasis of the numbers available, there was no significant difference (p = 0.16)between the sexes with regard to lateral condylar height. Theaverage difference was only 0.5 mm. There was asignificant difference (p = 0.001) between men and women with regard to medialcondylar height. However, the average difference was only 1.1 mm. While the difference betweenthe sexes with regard to anterior condylar height was nominal, themeasurements were highly variable regardless of sex. Onthe basis of the numbers available, there were no significant differencesbetween men and women with regard to the condylar aspect ratios.
结论：先前提到前髁的解剖差异是应用特定性别膝盖假体的三大原因之一。这里报道的纵横比，它是替代病人尺寸的数据，似乎否定了前髁解剖的性别差异。我们揭示了前髁解剖的个体差异非常大，而这与性别无关。我们相信，在设计植入物和手术技术时应该考虑到前髁解剖的差异性，不论性别力求再现解剖结构。
【原文】
Conclusions: Thedifference in anterior condylar anatomy is mentioned as one of three reasonsfor the need for a socalled gender-specific knee implant. The aspect ratio reported here, whichis a surrogate for patient size, seems to negate anydifference in anterior condylar anatomy based on sex. We have shown that anterior condylaranatomy is highly variable regardless of sex. We believe that implants as well assurgical techniques should be designed with the variability of anteriorcondylar anatomy taken into account and with an attempt toreproduce such anatomy regardless of sex.
附二（中英对照）：
体态和性别都影响TKA患者的膝盖形状
Both Morphotype and Gender Influence the Shapeof the Knee in Patients Undergoing TKA
Johan Bellemans MD, PhD, Karel Carpentier MD,
Hilde Vandenneucker MD, Johan Vanlauwe MD,
Jan Victor MD
Published online: 8 August 2009
_ TheAssociation of Bone and Joint Surgeons1 2009
摘要
膝盖尺寸的性别差异是否影响TKA组件的设计仍存在争议。我们假设，不仅性别，患者的体态同样决定了远端股骨和近端胫骨的形状，而且这个因素应该在设计特定性别的TKA假体时考虑到。
我们回顾了全部1000名在2003年四月到2007年七月之间做了TKA手术的欧洲白人患者，将他们按体态逐一分成三组：丰满体态，消瘦体态以及中等体态。
在250个最小的膝盖中，98%为女性，而在250个最大的膝盖中81%为男性。在中等大小的膝盖组中，女性膝盖比男性更窄。膝盖较小的患者（女性为主）体现了内外径从窄到宽之间的巨大差异，无论性别。同样的情况在较大的膝盖中（男性为主）也有所体现。
这种性别的差异可以部分由体态的差异来解释。体态短而宽（丰满体态）的患者，不论性别，膝盖较宽，而体态长而窄（消瘦体态）的患者其膝盖较窄。因此膝盖的形状不仅仅取决于性别，同样取决于体态。
证据等级：证据Ⅰ，诊断研究，请参阅作者关于证据等级的完整描述。
【原文】
Abstract
There is an ongoingdebate whether gender differences in the dimensions of theknee should influence the design of TKA components. We hypothesized that not only gender butalso the patient’s morphotype determined the shape ofthe distal femur and proximal tibia and that this factor should be taken intoaccount when designing gender-specific TKA implants.
We reviewed all 1000 European whitepatients undergoing TKA between April 2003 and June 2007 and stratified eachinto one of three groups based on their anatomic constitution:endomorph, ectomorph, or mesomorph.
Of the250 smallest knees, 98% were female, whereas 81% of the 250 largest knees were male.Inthe group with intermediate-sized knees, female knees were narrower than maleknees. Patients with smaller knees (predominantlyfemale) demonstrated large variability between narrow andwide mediolateral dimensions irrespective of gender. Thesame was true for larger knees (predominantly male).
This variability withingender could partially be explained by morphotypic variation. Patientswith short and wide morphotype (endomorph) had, irrespective of gender, widerknees, whereas patients with long and narrow morphotype (ectomorph) hadnarrower knees. The shape of the knee is therefore not onlydependent on gender, but also on the morphotype of the patient.
Level of Evidence: LevelⅠ, diagnostic study. See Guidelines for Authors for a completedescription of levels of evidence.