股骨远端解剖形态性别差异与假体形态设计的关系

Sexual difference of the distal femur in the design of knee prosthesis

目的:通过三维螺旋CT重建正常人膝关节,测量股骨远端相关解剖参数,探讨男女性股骨远端的解剖特点对于关节表面假体形态的不同要求。方法:80侧正常成人膝关节,男性、女性各40侧,年龄18￣72岁,行三维螺旋CT扫描,在GE Advantage workstation工作站上进行0.625mm层厚重建,测量股骨经上髁轴线宽度、内外侧髁高度、髁间高度及内外侧滑车前突距离,行模拟截骨后,测量各截骨面高度,比较各测量值性别间的差异。结果:男女性髁间高度、经上髁轴线宽度、外侧髁高度及内侧髁高度均有显著性差异(P<0.001),男性各值均大于女性。股骨远端横径与纵径的比值亦为男性大于女性(P<0.001),男性股骨内、外侧滑车前突距离均大于女性,均值差分别为1.2mm和0.7mm,均有显著性差异(P<0.001)。结论:男女性之间股骨髁形态存在一定差别,股骨远端关节面假体形态的设计应该性别差异化,使假体与截骨面更好的吻合。以提高全膝关节置换术的手术效果。

Objective： To measure anatomic parameters of the distal femur in total knee arthroplasty （TKA）, and discuss difference between the gender and the design of the femoral prosthesis. Mothods： 80 nomal knees of Chinese adults （male 40, female 40, age： 18-72 years） examined by MSCT scanning and 0.625mm-gap three-dimensional reconstruction of the distal femur was performed on GE Advantage workstation. Then, the height of the femur intercondyles and width of the femur through the tmnsepicondylar line were measured. The height of the medial and the lateral condyles, the distance between the anterior process of the medial and lateral trochleas were recorded. All the data was grouped and a comparison was preformed by gender. Results： The parameter values of the male femur were bigger than those of the women, including the height of the femur intercondyles and width of the femur through the transepicondylar line, the height of the condylars and the anterior process of trochleas （P〈0.001）. Moreover, there was a difference of the ratio of the mediaUateral diameter and anteroposterior diameter between genders. Conclusions： There are certain anatomic differences in the distal femur between male and female. The authors suggest that the femoral prosthesis should be designed by genders to ensure a good outcome in TKA.