基于磁共振成像测量的中国人群膝关节形态学指标对国产关节假体研发的价值
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摘要
目的旨在通过MRI测量的中国人群膝关节的解剖和形态学特点,为国产全膝关节置换的假体设计提供研发数据。方法选取2018年1—6月因膝关节疼痛或软组织损伤在同济大学附属第十人民医院放射科行膝关节MRI检查的患者412例,男192例、女220例。测量患者膝关节股骨远端和胫骨近端的一系列线性参数和角度参数,比较男性与女性患者间膝关节股骨远端和胫骨近端参数的差异。结果男性患者的股骨远端线性参数,通髁轴(TEA)、股骨髁内外侧宽度(ML)、外侧髁高度(AP)、股骨外上髁最高点至后髁线(PCL)外侧切点的距离(LAP)、股骨内上髁最高点至PCL内侧切点的距离(MAP)、后髁距离(PML)、上髁距离(AML)均显著大于女性患者(P值均<0.01);男性与女性患者间角度参数,股骨远端上髁间角(∠AOB)、上髁角(∠ACT)、后髁角(∠PCT)的差异均无统计学意义(P值均>0.05)。男性患者的胫骨近端线性参数,胫骨前后径最大值(AP’,即胫骨结节中内1/3与后交叉韧带的中点连线)、胫骨平台内外径最大值(ML’)、内侧胫骨平台的宽度(MPW)、胫骨外侧平台宽度(LPW)、胫骨内侧平台高度(MPH)、胫骨外侧平台高度(LPH)均显著大于女性患者(P值均<0.01)。男性患者的股骨面率(AP/ML)显著大于女性患者(P<0.01),PML/AML和MAP/LAP与女性患者的差异均无统计学意义(P值均>0.05);男性与女性患者间胫骨面率(AP’/ML’)、LPW/LPH和MPW/MPH的差异均无统计学意义(P值均>0.05)。男性与女性患者间股骨外侧髁、股骨内侧髁、胫骨外侧平台、胫骨内侧平台、髌骨的软骨厚度的差异均无统计学意义(P值均>0.05)。结论不同性别间膝关节形态学参数存在差异,并与文献所示西方人的数据存在差异,为今后国产膝关节假体的个性化设计提供了理论基础。
Objective To investigate the anatomic and morphologic characteristics of knees of Chinese people based on magnetic resonance imaging(MRI) measurements, and to provide parameters for prosthesis design of total knee arthroplasty. Methods A total of 412 patients who received MRI scans due to pain or soft tissue injury of the knee between January 2018 and June 2018 were recruited in this study. There were 192 males and 220 females. A set of linear and angular parameters of distal femur and proximal tibia were measured and compared between sexes. Results Parameters of the distal femur of the male patients, including transepicondylar axis(TEA), mediolateral length(ML), anteroposterior height(AP), lateral anteroposterior height(LAP), medial anteroposterior height(MAP), posterior mediolateral length(PML), and anterior mediolateral length(AML) were significantly larger than those of the females(all P<0.01). There was no significant difference in the angle measurements, including the angle of anterior condyles in the distal femur(∠AOB), anterior condylar angle(∠ACT), or posterior condylar angle(∠PCT), between sexes(all P>0.05). Parameters of the proximal tibia of the male patients, including anteroposterior height(AP'), mediolateral width(ML'), medial plateau mediolateral width(MPW), lateral plateau mediolateral width(LPW), medial plateau anteroposterior height(MPH), and lateral plateau anteroposterior height(LPH) were significantly larger than those of the females(all P<0.01). The ratio of AP to ML(AP/ML) in the males was also significantly larger than that in the females(P<0.01). No significant differences were found in PML/AML, MAP/LAP, AP'/ML', LPW/LPH or MPW/MPH between sexes(all P>0.05). Neither were the thicknesses of cartilage on the lateral and medial condylar of the femur, lateral and medial plateau of the tibia and the patella(all P>0.05). Conclusion The anatomic and morphologic parameters of the knee in Chinese men are different from those of women, and they are significantly different from the western parameters. This study provides references for the individualized design of prosthesis of the knee.(Shanghai Med J, 2019, 42: 357-361)
Objective To investigate the anatomic and morphologic characteristics of knees of Chinese people based on magnetic resonance imaging(MRI) measurements, and to provide parameters for prosthesis design of total knee arthroplasty. Methods A total of 412 patients who received MRI scans due to pain or soft tissue injury of the knee between January 2018 and June 2018 were recruited in this study. There were 192 males and 220 females. A set of linear and angular parameters of distal femur and proximal tibia were measured and compared between sexes. Results Parameters of the distal femur of the male patients, including transepicondylar axis(TEA), mediolateral length(ML), anteroposterior height(AP), lateral anteroposterior height(LAP), medial anteroposterior height(MAP), posterior mediolateral length(PML), and anterior mediolateral length(AML) were significantly larger than those of the females(all P<0.01). There was no significant difference in the angle measurements, including the angle of anterior condyles in the distal femur(∠AOB), anterior condylar angle(∠ACT), or posterior condylar angle(∠PCT), between sexes(all P>0.05). Parameters of the proximal tibia of the male patients, including anteroposterior height(AP'), mediolateral width(ML'), medial plateau mediolateral width(MPW), lateral plateau mediolateral width(LPW), medial plateau anteroposterior height(MPH), and lateral plateau anteroposterior height(LPH) were significantly larger than those of the females(all P<0.01). The ratio of AP to ML(AP/ML) in the males was also significantly larger than that in the females(P<0.01). No significant differences were found in PML/AML, MAP/LAP, AP'/ML', LPW/LPH or MPW/MPH between sexes(all P>0.05). Neither were the thicknesses of cartilage on the lateral and medial condylar of the femur, lateral and medial plateau of the tibia and the patella(all P>0.05). Conclusion The anatomic and morphologic parameters of the knee in Chinese men are different from those of women, and they are significantly different from the western parameters. This study provides references for the individualized design of prosthesis of the knee.(Shanghai Med J, 2019, 42: 357-361)
引文
[1] RUTHERFORD R W,JENNINGS J M,DENNIS D A.Enhancing recovery after total knee arthroplasty[J].Orthop Clin North Am,2017,48(4):391-400.
[2] JOICE M G,BHOWMICK S,AMANATULLAH D F.Perioperative physiotherapy in total knee arthroplasty[J].Orthopedics,2017,40(5):e765-e773.
[3] 彭慧明,蒋超,翁习生.运动力学对线在初次全膝关节置换术中的应用研究进展[J].中华骨与关节外科杂志,2017,10(5):446-449.
[4] DALL’OCA C,RICCI M,VECCHINI E,et al.Evolution of TKA design[J].Acta Biomed,2017,88(2S):17-31.
[5] BERGER R A,RUBASH H E,SEEL M J,et al.Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis[J].Clin Orthop Relat Res,1993 (286):40-47.
[6] GRIFFIN F M,INSALL J N,SCUDERI G R.The posterior condylar angle in osteoarthritic knees[J].J Arthroplasty,1998,13(7):812-815.
[7] YIP D K,ZHU Y H,CHIU K Y,et al.Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty[J].J Arthroplasty,2004,19(5):613-619.
[8] RISITANO S,INDELLI P F.Is “symmetric” gap balancing still the gold standard in primary total knee arthroplasty?[J].Ann Transl Med,2017,5(16):325.
[9] KUZYK P R T,WATTS E,BACKSTEIN D.Revision total knee arthroplasty for the management of periprosthetic fractures[J].J Am Acad Orthop Surg,2017,25(9):624-633.
[10] DONELL S.Patellar tracking in primary total knee arthroplasty[J].EFORT Open Rev,2018,3(4):106-113.
[11] KOBAYASHI H,AKAMATSU Y,KUMAGAI K,et al.Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee?[J].J Arthroplasty,2015,30(3):479-483.
[12] MAHFOUZ M,ABDEL FATAH E E,BOWERS L S,et al.Three-dimensional morphology of the knee reveals ethnic differences[J].Clin Orthop Relat Res,2012,470(1):172-185.
[13] SONG S J,DETCH R C,MALONEY W J,et al.Causes of instability after total knee arthroplasty[J].J Arthroplasty,2014,29(2):360-364.
[14] HITT K,SHURMAN J R,2nd,GREENE K,et al.Anthropometric measurements of the human knee:correlation to the sizing of current knee arthroplasty systems[J].J Bone Joint Surg Am,2003,85-A (Suppl 4):115-122.
[15] CHIN K R,DALURY D F,ZURAKOWSKI D,et al.Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty[J].J Knee Surg,2002,15(4):213-217.
[16] 李梁,吴海山.国人股骨远端形态测量在全膝关节置换与假体设计中的意义[J].中国组织工程研究,2013,17(43):7521-7526.
[17] 茅凌洲,朱裕昌,吴海山,等.国人女性人工全膝关节胫骨平台假体匹配度队列研究[J].同济大学学报(医学版),2018,39(1):103-108.
[18] FREEDMAN B R,SHEEHAN F T,LERNER A L.MRI-based analysis of patellofemoral cartilage contact,thickness,and alignment in extension,and during moderate and deep flexion[J].Knee,2015,22(5):405-410.
[2] JOICE M G,BHOWMICK S,AMANATULLAH D F.Perioperative physiotherapy in total knee arthroplasty[J].Orthopedics,2017,40(5):e765-e773.
[3] 彭慧明,蒋超,翁习生.运动力学对线在初次全膝关节置换术中的应用研究进展[J].中华骨与关节外科杂志,2017,10(5):446-449.
[4] DALL’OCA C,RICCI M,VECCHINI E,et al.Evolution of TKA design[J].Acta Biomed,2017,88(2S):17-31.
[5] BERGER R A,RUBASH H E,SEEL M J,et al.Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis[J].Clin Orthop Relat Res,1993 (286):40-47.
[6] GRIFFIN F M,INSALL J N,SCUDERI G R.The posterior condylar angle in osteoarthritic knees[J].J Arthroplasty,1998,13(7):812-815.
[7] YIP D K,ZHU Y H,CHIU K Y,et al.Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty[J].J Arthroplasty,2004,19(5):613-619.
[8] RISITANO S,INDELLI P F.Is “symmetric” gap balancing still the gold standard in primary total knee arthroplasty?[J].Ann Transl Med,2017,5(16):325.
[9] KUZYK P R T,WATTS E,BACKSTEIN D.Revision total knee arthroplasty for the management of periprosthetic fractures[J].J Am Acad Orthop Surg,2017,25(9):624-633.
[10] DONELL S.Patellar tracking in primary total knee arthroplasty[J].EFORT Open Rev,2018,3(4):106-113.
[11] KOBAYASHI H,AKAMATSU Y,KUMAGAI K,et al.Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee?[J].J Arthroplasty,2015,30(3):479-483.
[12] MAHFOUZ M,ABDEL FATAH E E,BOWERS L S,et al.Three-dimensional morphology of the knee reveals ethnic differences[J].Clin Orthop Relat Res,2012,470(1):172-185.
[13] SONG S J,DETCH R C,MALONEY W J,et al.Causes of instability after total knee arthroplasty[J].J Arthroplasty,2014,29(2):360-364.
[14] HITT K,SHURMAN J R,2nd,GREENE K,et al.Anthropometric measurements of the human knee:correlation to the sizing of current knee arthroplasty systems[J].J Bone Joint Surg Am,2003,85-A (Suppl 4):115-122.
[15] CHIN K R,DALURY D F,ZURAKOWSKI D,et al.Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty[J].J Knee Surg,2002,15(4):213-217.
[16] 李梁,吴海山.国人股骨远端形态测量在全膝关节置换与假体设计中的意义[J].中国组织工程研究,2013,17(43):7521-7526.
[17] 茅凌洲,朱裕昌,吴海山,等.国人女性人工全膝关节胫骨平台假体匹配度队列研究[J].同济大学学报(医学版),2018,39(1):103-108.
[18] FREEDMAN B R,SHEEHAN F T,LERNER A L.MRI-based analysis of patellofemoral cartilage contact,thickness,and alignment in extension,and during moderate and deep flexion[J].Knee,2015,22(5):405-410.