股骨滑车沟解剖学形态的CT研究

摘要

Objective To explore the anatomical morphology of femoral trochlear groove and the difference between normal males and females.Methods Eighty healthy volunteers were recruited,including 42 males and 38 females with an average age of 36.2 years (range,21-55 years).All the volunteers without knee unstabilization,pain and wound.CT scan of right femurs were performed and 3-D model were reconstructed.The anatomical parameters of right femoral trochlear groove were measured,which included transepicondylar axis,medial and lateral length of trochlear groove,medial and lateral condylar height,sulcus angle,depth of trochlear groove,transcondylar axis,anterior femoral condylar angle,trochlear groove position,and then compared the morphologic difference of trochlear groove between males and females.Results The average width of transepicondylar axis was 79.21±3.80 mm for males and 70.73±2.91 mm for females (t=-53.40,P=0.00).The minimum sulcus angle was acquired at 45° flexion for males and 42° flexion for females.It was 133.92°±4.76° for males and 132.71°±4.36° for females.The maximum length of transepicondylar axis was acquired at 87° flexion for males and 90° flexion for females.It was 42.36±3.48 mm for males and 39.03 ±3.36 mm for females.The anterior femoral condylar angle decreased with the increasing flexion angle of knee (P＞0.05).The position of the trochlear groove moved laterally with the increasing flexion angle of knee (P＞0.05).Conclusion There is no significant difference between male and female in the geometry of femoral trochlear groove,however there is a significant difference in sizes.Therefore,during design the knee prosthesis,close approximation of size is essential,while gender differences in morphology need not be considered a factor.%目的 探讨正常股骨滑车沟的解剖学形态及其性别差异.方法 募集80名健康志愿者,男42名,女38名；年龄(21～55)岁,平均36.2岁.志愿者均无膝关节不稳定、疼痛及膝关节外伤史.摄右侧股骨全长CT片,进行三维重建后测量经髁上轴宽度、滑车沟内外边长度、内外髁高度、滑车沟角、滑车沟深度、经内外侧髁轴长度、前股骨髁角、滑车沟位置.比较男女两组上述形态学指标的差异.结果 男女两组经髁上轴宽度分别为(79.21±3.80) mm、(70.73±2.91) mm,差异有统计学意义；滑车沟角在屈膝45°和42°取得极小值,分别为133.92°±4.76°和132.71°±4.36°；经内外侧髁轴长度在屈膝87°和90°取得最大值,分别为(42.36±3.48) mm和(39.03±3.36) mm；前股骨髁角均随屈膝角度增加而变小,两组差异无统计学意义；滑车沟位置均随屈膝角度增加而外移,两组差异无统计学意义.结论 股骨滑车沟的解剖形态不存在性别差异,而其尺寸存在性别差异.在假体设计中可细化全膝关节假体的滑车沟尺寸,以提供更好的形态匹配,无须考虑滑车沟的性别差异.