中国汉族人与美国高加索白人膝关节几何形态的比较

Comparison of knee geometry between Chinese Han people and American Caucasians

背景:有研究显示中国人膝关节胫骨近端前后径和横径均小于美国高加索人,所以在膝关节形态学方面存在一定差异,因此常发生进口假体系统应用于国人后出现匹配度不高的现象。目的:测量中国人和美国人股骨远端、胫骨近端的几何形态学参数,比较其差异。方法:选择北京清华长庚医院骨科拟行前交叉韧带重建的中国汉族患者50例,以及美国匹兹堡大学运动医学中心拟行前交叉韧带重建的高加索白人后裔患者40例,对90例受试者膝关节进行CT扫描,使用AW Volume Share 5软件进行三维重建,利用Geomagic软件对胫骨近端和股骨远端的各项参数进行测量。结果与结论:①股骨近端测量参数中,中国人的外侧胫骨平台内外径小于美国人(P=0.027),外侧胫骨平台后倾角大于美国人(P<0.05);两组间胫骨平台内外径、内侧胫骨平台外径、内侧胫骨平台前后径、外侧胫骨平台前后径与内侧胫骨平台后倾角比较差异均无显著性意义(P>0.05);②股骨远端测量参数中,中国人的股骨远端横径、外侧髁内外径、内侧髁前后径、外侧髁前后径及髁间窝高度均小于美国人(P<0.05),股骨外翻角大于美国人(P<0.05);两组间内侧髁内外径、髁间窝宽度及滑车沟宽度比较差异无显著性意义(P>0.05);③结果表明,中国人与美国人在膝关节形态学的多个参数存在差异,有必要针对中国人设计更为个体化的膝关节假体。

BACKGROUND: Some studies have shown that the anterior and posterior diameters and transverse diameters of the proximal tibia of the Chinese knee are smaller than those of the Caucasian in the United States, so there are some differences in the morphology of the knee, so the phenomenon of low matching degree often occurs when the imported prosthesis system is applied to the Chinese. OBJECTIVE: To measure the geometric parameters of the distal femur and the proximal tibia of Chinese and American, compare the differences. METHODS: The 50 Chinese Han patients planned to undergo anterior cruciate ligament reconstruction in the Department of Orthopedics, Beijing Tsinghua Changgung Hospital and 40 Caucasian patients planned for anterior cruciate ligament reconstruction at the University of Pittsburgh Sports Medicine Center were selected. The knee joints of 90 subjects were scanned by Computed Tomography. Three-dimensional reconstruction was performed by AW Volume Share 5 software. The Geomagic software was used to measure the parameters of the distal femur and proximal tibia. RESULTS AND CONCLUSION:(1) In the measurement parameters of the proximal femur, the inner and outer diameters of the lateral tibial plateau in Chinese were smaller than those of the American(P=0.027), and the posterior inclination of the lateral tibial plateau was greater in Chinese than that of the American(P<0.05). There was no significant difference in the inner and outer diameters of the tibial plateau, the outer diameter of the medial tibial plateau, the anteroposterior diameter of the medial tibial plateau, the anteroposterior diameter of the lateral tibial plateau, and the posterior inclination angle of the medial tibial plateau between the two groups(P>0.05).(2) In the measurement parameters of the distal femur, the transverse diameter of the distal femur, the medial and lateral diameters of the lateral condyle, the anteroposterior diameter of the medial condyle, the anteroposterior diameter of the lateral condyle, and the height of the intercondylar fossa were all less in Chinese than those of the American(P<0.05);the valgus angle of the Chinese femur was greater than that of the American(P<0.05). There was no significant difference in the inner and outer diameters of the medial condyle, the width of the intercondylar notch and the width of the trochlear groove between the two groups(P>0.05).(3) There are some differences in many parameters of knee morphology between Chinese and American. It is necessary to design more individualized knee joint prosthesis for Chinese.