骨关节炎患者胫骨平台偏心距性别差异分析

Analysis of gender differences in offset of tibial plateau in patients with osteoarthritis of Gansu province

目的测量甘肃地区膝内翻畸形的骨关节炎(OA)患者胫骨平台的解剖特点及胫骨平台中心到胫骨干中心的偏心距。方法选取2012年1月至2014年10月在兰州大学第二医院关节外科进行人工全膝关节置换术(TKA)的患者121例,所有患者均诊断为膝内翻畸形的骨关节炎,包括72例女性,49例男性,共126例膝,平均年龄(65±8)岁。排除类风湿性关节炎、屈曲或外翻畸形、创伤后关节炎、接受过胫骨或股骨截骨术和先天畸形等。使用64层三维重建CT扫描膝关节测量偏心距。所有测量的资料采用影像归档和通信系统(PACS)保存两次,由第三方未参与试验的研究者分析,作组内相关系数相关性分析,使用SPSS 13.0统计软件进行数据统计分析,两组之间比较采用t检验。结果研究显示甘肃地区骨关节炎患者的胫骨平台偏心距解剖有很大的变异。平均的偏心距是(7.6±3.0)mm,胫骨平台的前后和内外距离分别是(53.1±4.8)mm和(70.4±8.3)mm。偏心距性别差异分析显示无统计学意义(P>0.05),胫骨平台的内外径和前后径性别差异无统计学意义(P>0.05)。胫骨干轴线与胫骨平台的关系进行性别差异分析显示在胫骨软骨下水平横截面女性72%位于前外侧,男性却只有50%位于前外侧。结论甘肃地区骨关节炎患者的偏心距解剖数据不同于健康中青年人群,也不同于西方人群,但是无性别差异。在进行全膝关节置换(TKA)手术前,如果使用延长柄胫骨假体,术前必须做充分手术评估。

Objective To measure the anatomic features of the tibial plateau and to assess variations in the offset of the tibial shaft from the tibial plateau of osteoarthritis(OA)patients in Gansu Province.Methods A retrospectively review was carried out on 126 knees of 121 patients(72 females,49 males)who underwent total knee arthroplasty in orthopaedics department of Lanzhou University Second Hospital between April 2011 to October 2014,with an average age of(65±8)years.The inclusion criteria were knee OA with varus;the exclusion criteria were rheumatoid arthritis,flexion or valgus deformity,knee surgery history.The anatomic features of the tibial plateau were measured and analyzed using three-dimensional reconstruction information derived from the 64-slice spiral CT.All the measured data were analyzed by Picture Archiving and Communication System,and SPSS 13.0 software for the intraclass correlation coefficient analysis.The comparison between the two groups was performed by t test.Results This study showed that significant variations in the proximal tibial anatomy among the subjects.The mean offset was(7.6±3.0)mm at the resection just distal to the subchondral bone.The mean anteroposterior and mediolateral dimensions of the tibial plateau were(53.1±4.8)mm and(70.4±8.3)mm at the resection just distal to the subchondral bone.There was no significant difference between male and female in offset of the tibial plateau(P>0.05).There was 50%located anterolateral to the center of the tibial plateau in male,while there was 72%located anterolateral to the center of the tibial plateau in female at the resection just distal to the subchondral bone.Spss 13.0 software was used for the statistical analysis.Conclusions There are anatomic variations in the offset of the tibial shaft from the tibial plateau of OA patients in China.However,there is no significant difference between male and female.A wide range of implant sizes is thus necessary before TKA.