国人胫骨平台截骨面与西方进口胫骨假体解剖学参数的偏差

摘要

目的 测量中国北方汉族人胫骨平台截骨面与进口胫骨假体解剖学参数的偏差.方法 中国北方汉族健康志愿者82名(135膝),男52名(85膝),女30名(50膝);年龄19～ 82岁,平均47.2岁.行膝关节横断面CT扫描,获得“.dicom”格式图像.将图像存储至与CT机联网的计算机三维重建工作站(Adw 4.3),利用三维容积重建软件建立膝关节三维图像.对三维图像的胫骨进行旋转、切割,测量不同截骨高度及后倾角度各截骨面的胫骨近端横径、前后径及纵横比;采用5 mm容差范围法对三种西方进口假体(A、B、C)与国人胫骨平台截骨面的匹配程度进行初步评估.结果 男性胫骨近端截骨面横径平均值为(78.03±2.92) mm,女性为(69.85±2.70)mm;男性胫骨近端截骨面前后径平均值为(50.62±2.46)mm,女性为(46.14±2.61)mm;男性胫骨近端截骨面纵横比平均值为0.649±0.032,女性为0.661±0.031.不同性别胫骨近端截骨面横径与前后径的差异均有统计学意义,男性大于女性;纵横比平均值女性大于男性,差异有统计学意义.假体A对所有受试者各截骨面的平均涵盖率为42.55％,假体B平均为44.61％,假体C平均为27.41％.A与B两种假体涵盖率的差异无统计学意义,而两者与假体C涵盖率的差异均有统计学意义.结论 国人正常胫骨平台截骨面的几何形态与西方进口假体的匹配度普遍较低.%Objective To obtain the linear parameters of proximal tibia in normal Chinese,and study the anatomical differences between the resected tibial surfaces and tibial baseplates of total knee prostheses.Methods A total of 82 normal Chinese / 135 knees (include 85 male and 50 female knees) was included,with an average age of 47.2 (range,19-82) years.All of the volunteers were scanned by Spiral CT,and the original CT images were stored in the work station (Adw 4.3).Then 3-D models of Chinese normal knees were reconstructed and two parameters were measured through volume reconstruction software,including mediolateral (ML) width and anterioposterior (AP) length.A coordinate system was formed with the mediolateral width as the X-axis and anterioposterior length as the Y-axis.A circle,5 mm in diameter,was used as the maximum coverage criterion.Three contemporary products (A,B,C) were used to analyze the data.From the results,we calculated the coverage percentage of the patients.Results The average ML width and AP length of the proximal tibia section were 78.03±2.92 mm and 50.62±2.46 mm in male,and 69.85±2.70 mm and 46.14±2.61 mm in female,respectively.The average ratio of AP length and ML width (RAP/ML) was 0.649 ±0.032 in male and 0.661± 0.031 in female,respectively.AP length and ML width showed statistical significance between different genders.The RAP/ML was larger in female,and the difference was statistically significant.The average coverage rate of prosthesis A,B and C was 42.55％,44.61％ and 27.41％,respectively.There was no statistically significant difference between prosthesis A and B.However,all of them showed statistical significance with prosthesis C.Conclusion The geometry and anatomy of proximal tibia in Chinese showed significant differences with that in Western.Those characteristic differences should be considered when we use the tibial plateau prosthesis designed by the Westerners.