大骨节病膝关节股骨远端解剖形态数字学研究及其意义

Digital Morphometry Study of Distal Femoral Anatomy in KBD Patients and Its Significance

目的:通过CT测量适合行全膝关节置换术(total knee arthroplasty,TKA)的大骨节病膝关节股骨远端解剖参数,为行TKA的大骨节病股骨假体的设计提供参考依据。方法:选取适合TKA的大骨节病和骨性关节炎患者进行膝关节CT扫描,用Mimics软件进行三维重建并测量股骨内外径(femoral mediolateral,ML)、股骨外侧髁前后径(lateral anteroposterior,LAP)、股骨内侧髁前后径(medial anteroposterior,MAP)、股骨内侧髁宽(medialcondylar width,MCW)、股骨外侧髁宽(lateral condylar width,LCW),并计算ML/LAP比值,比较股骨远端各解剖形态参数差异。结果:大骨节病组股骨远端各解剖数据测量值(ML、MAP、LAP、MCW、MCW)均小于骨性关节炎组,差异有统计学意义(P <0.01)。大骨节病股骨远端ML/LAP比值明显大于骨性关节炎组,显示一个给定LAP的股骨假体,大骨节病股骨远端ML有可能会覆盖不全,骨性关节炎有可能会悬空。结论:大骨节病膝关节股骨远端解剖形态与骨性关节炎存在一定差异,为设计适合大骨节病的TKA人工股骨假体提供理论依据。

Objective: To measure and analyze anatomic parameter of distal femur in Kaschin-Beck disease(KBD) patients which candidate for total knee arthroplasty(TKA). Method:95 knees(46 KBD, 49 OA) were measured by CT for the distal femoral mediolateral(ML), lateral anteroposterior(LAP), medial anteroposterior(MAP), medial condylar width(MCW), lateral condylar width(LCW) and ML/LAP aspect ratio to compared the morphometric differences of distal femur between KBD and OA knees.Result: There were significant differences between KBD and OA knees in relation to ML, LAP, MAP, MCW and LCW dimensions(P <0.01). We also found that KBD have larger ML/LAP aspect ratio than that of OA knees under a given LAP dimension. This means that under a given LAP dimension component, the femoral ML dimension tended to undersized in KBD and overhang in OA knees.Conclusion: Distal femoral anatomy showed significant differences in the size and shape between KBD and OA knees, which provide vital theoretical basis for designing proper femoral prosthesis for KBD patients.