正常中国成年人相当于全膝关节置换胫骨近端截骨部位的形态学测量

Morphological measurement of proximal tibial resected surface in total knee arthroplasty of Chinese adults

背景:在人工全膝关节置换过程中,胫骨近端截骨后常出现胫骨截骨面与进口假体覆盖无法令人满意的结果。除了手术技术外,一个主要的原因是根据西方人群解剖学特征设计的胫骨金属假体与国人胫骨近端截骨面在形态学上存在差异。目的:对正常中国成年人膝关节胫骨近端截骨面进行形态学测量,分析与人工全膝关节置换相关的截骨面的形态学特征。方法:选取90例单侧膝关节疾患的正常中国成年人,按身高分为151～160cm组、161～170cm组、171～180cm组,对双膝关节进行CT扫描及三维重建。在CT断层图像上测量健侧胫骨近端截骨面的前后径、左右径、前后径/左右径值,分析各指标之间的相互关系,并比较胫骨近端截骨面前后径/左右径值与常用进口假体金属托数据之间的差异。结果与结论:随着身高的增加,男女性胫骨近端截骨面的前后径、左右径也相应增加,但其比值相应减小。胫骨近端截骨面前后径与左右径呈直线正相关,前后径/左右径值与左右径呈直线负相关。国人胫骨近端截骨面前后径/左右径值较目前常用进口假体胫骨托前后径/左右径比值大。提示国人胫骨近端截骨面形态上具有其自身特点,设计符合国人解剖特征的胫骨假体时,应适当增大前后径/左右径值。

BACKGROUND：The mismatch of resected surface and imported tibial baseplate usually occurs in operation of total knee arthroplasty （TKA）. The mainly reason,except surgical technology,is the difference of morphology of resected surface in Chinese population and imported knee prostheses designed according to western population. OBJECTIVE：To analyze features of resected surface in TKA by anthropometric measurements of proximal tibia on the level of resected surface of Chinese knees. METHODS：A total of 90 adults who had disorders in monolateral keens were selected and divided into 151-160 cm,161-170 cm,and 171-180 cm according to different height. The normal knee of each patient was scanned by CT. The three-dimensional solid models of normal knees were reconstructed by standard mode on CT work station. Anthropometric measurements of several parameters （anteroposterior （AP） and mediolateral （ML） dimension of resected surface,AP/ML ratio of resected surface,AP and ML dimension of medial and lateral resected surface） were performed. The correlations of the parameters were analyzed,and the data of tibial resected surface with several commonly imported tibial baseplates of total knee prosthesis were compared. RESULTS AND CONCLUSION：With increasing height,the AP and ML dimension increased and AP/ML ratio decreased. The AP dimension of resected surface was correlated positively with ML dimension of resected surface,and AP/ML ratio of resected surface showed negative correlation with ML dimension of resected surface. The AP/ML ratio of proximal tibial resected surface of Chinese population was greater than those of several commonly imported tibial baseplates of total knee prosthesis. The morphogy of resected surface of proximal tibia has obvious features. The AP/ML ratio should be appropriately raised while designing the tibial baseplates of total knee prosthesis for Chinese population.