髌股关节软骨与软骨下骨的几何学匹配性及临床意义

The clinical value of cartilagious surface and corresponding osseous contour of patellofemoral joint

目的 测量并比较髌股关节软骨覆盖和软骨下骨的几何形状.方法 2009年1月至2010年3月,选取髌股关节正常的膝关节标本9例,在膝关节屈曲20°～30°位,沿髌骨中心垂直于髌股关节面横行切开,暴露髌股关节,测量骨性髌骨适合角、软骨性髌骨适合角、髌骨软骨顶点参数、髌骨软骨下骨顶点参数、滑车骨性凹点参数和滑车软骨凹点参数.然后在临床中随机选取11例髌股关节软骨覆盖及力线正常患者的髌股关节轴位MRI,测量上述指标,与解剖学研究进行比较.结果 解剖学样本数据：骨性髌骨适合角为（-4.5±1.1）°,软骨性髌骨适合角为（0.5±0.8）°,均为右膝;髌骨软骨顶点参数为1.13±0.11,髌骨软骨下骨顶点参数为1.67±0.14,滑车骨性凹点参数为1.35±0.28,滑车软骨凹点参数为1.38±0.33.骨性髌骨适合角与软骨性髌骨适合角差异有统计学意义（P＜0.05）,髌骨软骨顶点参数与髌骨软骨下骨顶点参数差异有统计学意义（P＜0.05）.滑车骨性凹点参数与滑车软骨凹点参数差异无统计学意义（P＞0.05）.临床影像学样本数据和解剖学数据相近,差异无统计学意义（P＞0.05）.结论 覆盖髌骨软骨的几何形状与软骨下骨的几何形状存在着明显的差异,而股骨滑车软骨与软骨下骨的几何形状基本相似.

Objective To investigate if the cartilagious surface and corresponding osseous contour of the patellofemoral joint match in the axial plane for providing theoretical basis with evaluating alignment of patellofemoral joint and designing the part of patellofemoral joint in knee prosthesis. Methods From January 2009 to March 2010, 9 human cadaver knees were prepared, which ehandra of patellofemoral joint didn＇t degenerate. Each specimen was sectioned in the axial plane at 20° to 30° knee flax. The cross- sections revealed characteristics in the bony anatomy and corresponding articular surface geometry of the patellofemoral joint in the axial plane. Evaluating pramaters included osseous patella congruence angle （OPCA） , chondric patella congruence angle （CPCA） , patella chondric convex point parameter （PCCPP） , patella subehondral osseous convex point parameter （PSOCPP） , the parameters of the deepest （chondric or osseous） point of the intercondylar sulcus. After that, the osseous and cartilaginous contours and subehondral osseous contours of the patella in the axial plane were analyzed through MRI data of 11 patients who didn＇t degenerate in patellofemoral joint cartilage. Parameters as same as cadaver knees were compared. Results Data from specimens of OPCA was （ - 4. 5 ± 1.1 ）°, CPCA was （ 0. 5 ± 0. 8 ）°, PCCPP was 1.13 -＋0. 11, PSOCPP was 1.67 ±0. 14, PCDPIS was 1.35 -＋0. 28, PODPIS was 1.38 ±0. 33. Date from MRI of OPCA was （ - 3.8 ± 1.4）°, CPCA was （0. 7 ± 1.0）°, PCCPP was 1.05 ± 0. 21, PSOCPP was 1.73 ± 0. 18, PCDPIS was 1.41 ±0. 21, PODPIS was 1.37 ＋ 0. 27. The patella exhibited significant differences in the bony vs. chondric anatomy （ P 〈 0. 05 ） , but the intercondylar sulcus nearly match in the bony vs. chondric anatomy. Conclusions The eartilagious surface and corresponding osseous contour of the patella don＇t match in the patellofemoral joint axial plane, but that of the trochlea nearly matchs. This is very important for aeeuratelly evluating alignment of patellofemoral joint because the normal osseous alignment of patellofemoral joint don＇t represent the normal alignment and helpful for designing the part of patellofemoral joint in knee prosthesis.