摘要
背景:在全膝关节置换术中,经常发现胫骨近端截骨后,在选择胫骨假体时出现胫骨截骨面与假体覆盖不匹配的情况。这除了手术技术因素以外,更主要的原因可能是根据西方人群解剖学特征设计的胫骨平台假体在形态学上与国人胫骨近端截骨面的解剖特征存在差异。目的:建立华北地区正常成人胫骨近端三维模型,获得胫骨近端线性参数。设计、时间及地点:横断面抽样调查,病例来自2007-02/10北京潞河医院骨科及首都医科大学附属朝阳医院骨科。对象和材料:北京潞河医院骨科及首都医科大学附属朝阳医院骨科62名志愿者115个正常膝关节入选。所有志愿者均久居华北地区。男35例,女27例;年龄20～74岁。甲醛防腐处理的中国人尸体,膝关节无明显骨骼发育畸形,骨质无明显退变,无内外翻畸形。尸体来源于首都医科大学解剖教研室。方法:对62名志愿者115例正常膝关节进行MR矢状位扫描,胫骨近端三维重建后对各个截面的横径、前后径进行测量,采用SPSS10.0软件对数据进行统计学分析。尸体胫骨扫描后对尸体胫骨进行测量,与三维重建的胫骨近端模型相应测量参数进行比较分析。主要观察指标:胫骨近端截面横径,距离内外侧平台边缘10%,20%,30%点的前后径(Y1M、Y2M、Y3M、Y1L、Y2L、Y3L),外、内侧平台相应百分点前后径的比值。结果:截骨面横径Y=-0.654X+76.291,X为截骨厚度。在截骨厚度相等的情况下,男性横径大于女性,均数之差5.038～6.662mm。在截骨面上,距内、外侧平台边缘10%、20%、30%处的前后径依次为Y1M、Y2M、Y3M、Y1L、Y2L、Y3L,Y1M=-0.340X+40.318,Y2M=-0.425X+50.373,Y3M=-0.455X+53.742,Y1L=-0.211X+36.547,Y2L=-0.247X+42.583,Y3L=-0.256X+43.355。胫骨内侧平台前后径大于外侧,从平台的边缘到中心,这种差异性增加。随着截骨厚度的增加,内、外侧平台前后径的差异减少。在截骨厚度8mm时,内、外侧平台从周缘向内依次10%、20%、30%处的前后径之比分别是1:0.9273、1:0.8653、1:0.8274,没有性别差异性。男性的前后径大于女性,均数之差为2.323～3.027mm。尸体胫骨上手工测量与三维重建胫骨近端模型上测量的线性参数误差为1.431mm。结论:MRI三维重建的胫骨近端模型大小稍有偏差,但可以接受。胫骨近端线形参数个体差异性较大,与西方人比较存在差异性。
BACKGROUND： The tibial resected surface is unmatched with the prosthesis in patients received proximal tibial rescetion in total knee arthroplasty, that because the tibial plateau prosthesis was designed by westerners, which geometry and morphology data is different from Chinese people. OBJECTIVE： To reconstruct a three-dimensional proximal tibia model of North Chinese people, and to obtain linear parameters of Chinese proximal tibia. DESIGN, TIME AND SETTING： A transectional sampling survey. Cases were obtained from Department of Orthopaedics, Beijing Luhe Hospital and Department of Orthopaedics, Beijing Chaoyang Hospital, Capital University of Medical Sciences from February to October 2007. PARTICIPANTS AND MATERIALS： Sixty-two volunteers 115 healthy knee joints in Department of Orthopaedics, Beijing Luhe Hospital and Department of Orthopaedics, Beijing Chaoyang Hospital, including 35 males and 27 females, aged 20 74 years. All volunteers were lived in North China area. The cadavers without skeletal dysplasia or varus and valgus deformities were provided by Department of Anatomy, Capital University of Medical Sciences. METHODS： Totally 115 Chinese normal proximal tibias were studied by sagittal scanning. After constructing three-dimensional reconstruction models, the transverse diameter, and anteroposterior diameter of proximal tibia was measured and analyzed with statistical analysis. The data of cadavers were measured and compared with parameters from 3D proximal tibia models. MAIN OUTCOME MEASURES： The transverse diameter, anteroposterior diameter at points 10%, 20% and 30% of medial and lateral plateau （Y1M, Y2M, Y3M, Y1L, Y2L, Y3L）, and the responding ratio of anteroposterior diameter. RESULTS： Tibial medial-lateral width Y= 0.654X＋76.291, Xwas the thickness of cutting. When the thickness of cutting was equal, the tibial medial-lateral width of male was larger than that of female. The mean difference was from 5.038-6.662 mm. The average anteroposterior 10%, 20%, and 30% from the medial to lateral, peripheries diameters were Y1M, Y2M, Y3M, Y1L, Y2L, Y3L, respectively. Y1M=-0.340X＋40.318, Y2M= 0425X＋50.373, Y3M = 0.455X＋53.742, Y1L=-0.211X＋36.547, Y2L= 0.247X＋42.583, Y3L= 0.256X＋43.355. The medial tibial plateau was larger than the lateral tibial plateau in the anteroposterior diameter,and more significantly, this anteroposterior difference increases as one moves away from the periphery of the tibial plateau toward the center.The difference between anteroposterior diameters of the medial tibial plateau and those of the lateral tibial plateau decreases as the thickness of cutting increases. When the thickness of cutting was 8 mm, the ratios of the medial/lateral anteroposterior distances at 10%, 20%, and 30% from the periphery were 1：0.927 3, 1：0.865 3, and 1：0.827 4, respectively. The ratios had no difference between male and female. The mean anteroposterior distances in male were larger than those in female, with mean difference of 2.323 3.027 mm. The mean errors between data measured manually from cadavers directly and the data measured from 3D proximal tibia models of cadavers were 1.431 mm in linear parameters. CONCLUSION： Although both the manual measurement from cadavers directly and the measurement from 3D proximal tibia models present errors, the range of the errors may be accepted. The geometeric parameters of the proximal tibia shows marked individual variation, which has significant difference to westerners.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第17期3241-3246,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
