基于人类进化节奏差异造成的人种胫骨平台解剖偏差对膝关节假体设计的影响

Effects of anatomical deviation of the human tibial plateau on knee prosthesis design based on human evolutionary rhythm differences

目的分析进口膝关节假体与国人胫骨平台截骨面的匹配程度,探讨其对膝关节假体设计的影响及人类进化节奏的差异。方法回顾性研究。选取2018年1月—2020年1月首都医科大学附属北京朝阳医院骨科非膝关节疾病患者60例(120膝)、健康志愿者20名(40膝),其中男46例(92膝),女34例(68膝),年龄24~72岁、平均46.8岁。均行双侧膝关节CT扫描及三维重建,并在高级图像工作站(GE ADW 4.3)上对三维重建的胫骨图像进行旋转、切割,测量并比较不同性别被试胫骨平台截骨面横径、前后径等线性参数的差异;采用5 mm容差范围法,分别评估按照白种人体质参数设计生产的Depuy-PFC sigma(假体A)、Link-Gemini MK-Ⅱ(假体B)、Zimmer-Nexgen(假体C)3种进口假体与成年国人胫骨平台截骨面的匹配率,并采用χ^(2)检验进行比较。结果测得80例160膝成年国人胫骨平台截面横径为(74.2±2.8)mm,其中男性为(76.2±2.7)mm,大于女性的(68.1±2.9)mm,差异有统计学意义(t=18.18,P<0.001);前后径为(48.2±2.6)mm,其中男性为(50.5±2.5)mm,大于女性的(46.3±2.7)mm,差异有统计学意义(t=10.15,P<0.001)。假体A、假体B、假体C与受试者胫骨平台截骨面的匹配率分别为41.25%(66/160)、46.88%(75/160)和26.25%(42/160),假体C低于假体A和假体B,差异均有统计学意义(χ^(2)=8.05、14.67,P值均<0.05),而假体A与假体B间差异则无统计学意义(χ^(2)=1.03,P=0.184)。结论基于白种人体质参数设计的进口膝关节假体与中国人胫骨平台截骨面的匹配度普遍较低;国人正常胫骨平台截骨面的几何形态同白种人有明显的区别,因此国人膝关节假体设计时不能照搬白种人的体质参数。中国人的胫骨平台截面相对较圆,因而推测在人类的进化过程中,中国人从四肢行走到直立行走可能较白种人更早。

Objective This work aimed to explore the differences in human evolutionary rhythm,analyze the matching rate of imported knee prosthesis and the tibial plateau osteotomy surface of Chinese adults,and determine the influence of the tibial plateau on the design of knee prostheses.Methods In this study,60 patients(120 knees)with non-knee diseases and 20 healthy volunteers(40 knees)were selected from the Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University from January 2018 to January 2020.The patients included 46 males(92 knees)and 34 females(68 knees).The patients were 24-72 years old,with an average age of 46.8 years.Bilateral knee CT scan and 3D reconstruction were performed,and 3D reconstructed tibial images were rotated and cut on GE ADW 4.3 Advanced Image Workstation.Linear parameters such as transverse diameter and anteroposterior diameter of tibial plateau osteotomy surface were measured and calculated,and the differences in parameters between men and women were compared.Statistical analysis was performed.The matching rates of three imported knee prostheses designed based on Caucasian physique parameters(Depuy PFC Sigma[prosthesis A],Link-Gemini MK-II[prosthesis B],and Zimmer Nexgen[prosthesis C])and the tibial plateau osteotomy surface of Chinese adults were evaluated using the 5 mm tolerance range method.Pairwise comparison was performed byχ^(2) test.Results The mean cross diameter of the tibial plateau was(74.2±2.8)mm in 80 Chinese adults with 160 knees;that of males was(76.2±2.7)mm,which was higher than that of females(68.1 mm±2.9 mm),and the difference was significant(t=18.18,P<0.001).The mean diameter was(48.2±2.6)mm;that of males was(50.5±2.5)mm,which was higher than that of females(46.3 mm±2.7 mm),with statistical significance(t=10.15,P<0.001).The matching rates of prostheses A,B,and C with the tibial plateau osteotomy surface of Chinese adults were 41.25%(66/160),46.88%(75/160),and 26.25%(42/160),respectively.The matching rates of prosthesis C were lower than those of prostheses A and B,and the differences were statistically significant(χ^(2)=8.05,14.67,all P values<0.05).No significant difference was found between prostheses A and B(χ^(2)=1.03,P=0.184).Conclusion A significant difference is noted between Chinese adults and Caucasians in the normal bearing surface of the tibial plateau.The matching degree between imported knee prosthesis and the tibial plateau osteotomy surface of Chinese adults is generally low.The tibial plateau section of Chinese adults is relatively round,which suggests that in the course of human evolution,Chinese walked from four limbs to upright maybe earlier than Caucasians.