行初次全髋关节置换国人正常股骨髓腔近端解剖参数研究及其影响因素分析

Anatomic basis of femoral prosthesis design for total hip arthroplasty in Chinese population

[目的]探讨中国人正常股骨髓腔近端解剖特点,研究股骨形态学参数影响因素,为设计更适合国人特点的假体提供解剖依据。[方法]选取本院2009年1月~2015年8月诊断为骨性关节炎、股骨头无菌性坏死行初次全髋关节置换的患者共502人(572髋),术前拍摄患肢标准髋关节正侧位X线片,应用PACS医学图像处理系统测量股骨近端解剖参数。对比中国人与西方人股骨近端解剖参数差异,应用多元线性回归分析性别、年龄、身高、体重、是否饮酒对股骨近端髓腔解剖结构的影响。[结果]本组国人正常股骨髓腔近端解剖参数与Noble测量欧美人种的解剖参数均有差异。年龄、长期饮酒史对髓腔形态影响具有统计学意义。[结论]建立股骨近端解剖参数数据库,并设计出符合国人解剖特点的股骨侧假体是十分重要的。种族、年龄、长期饮酒史等因素需纳入假体柄设计的过程中。

[Objective] To explore the anatomic characteristics of proximal femoral cavity and its morphological parameters in the Chinese population, and provide anatomic basis for the design of prosthesis. [Method] A total of 502 patients diagnosed with osteoarthritis or aseptic necrosis of femoral head, and already treated by total hip arthroplasty（572 surgeries） in our hospital from January 2009 to August 2015, were selected in this research. Based on anterior-posterior X-ray photograph of affected extremity＇s hip joint, the proximal femur anatomic parameters were measured using the picture archiving and communication systems（PACS）. The data were compared with western people＇s proximal femur anatomic parameters. Furthermore, the gender, age, height, weight, and drinking were screened for influence factors to the anatomic structure of femoral proximal medullary cavity by using multiple linear regression method. [Results] The anatomic parameters of proximal femoral cavity in this series showed significant differences with those measured by Noble for the American and European population. Age and chronic alcohol consumption had statistically significant influences on anatomic characteristics. [Conclusions] A database of proximal femur anatomic parameters for Chinese population is necessary and important. Meanwhile, the relevant influence factors such as race, age, chronic alcohol consumption should be considered for the design of prosthesis.