胫骨及胫骨远端CT影像解剖形态学研究  

Anatomic study on CT images of tibia and the distal segment of the tibia

作　　者：赵坤 姚凯 周勇[1] 王杰[1] 卢敏勋 唐凡[1] 肖聪[1] 王延岭[1] 王一天 周思私 闵理[1] 罗翼[1] 张闻力[1] 屠重棋[1] Zhao Kun;Yao Kai;Zhou Yong;Wang Jie;Lu Minxun;Tang Fan;Xiao Cong;Wang Yanling;Wang Yitian;Zhou Sisi;Min Li;Luo Yi;Zhang Wenli;Tu Chongqi

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华解剖与临床杂志》2018年第5期365-370,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家重点研究开发项目(2016YFCll02003);四川省科技研究项目(2017SZ0095)

摘　　要：目的 探讨西南地区正常成人胫骨远端CT影像解剖学及形态学特征,为治疗胫骨干远端极限骨缺损新型保踝胫骨干假体的设计提供理论依据.方法 回顾性分析2014年1月—2017年10月于四川大学华西医院行CT检查的107例正常胫骨CT影像资料,其中男57例、女50例,年龄20~40(29.8±5.2)岁.应用Mimics软件测量胫骨上下关节面长度(L1)、胫骨平台最低点到髓腔最狭窄部位的长度(L2)、能保留下胫腓韧带的最短胫骨长度(L4)、狭窄段的长度(L5)、最狭部最薄皮质骨厚度(L6)、最狭窄部直径(D1)、胫骨远端关节面最高点上4 cm处胫骨截骨面最贴合髓腔椭圆长径(D2)、短径(D3)以及D2与胫骨冠状轴夹角(∠α)等参数;采用独立样本t检验分析上述参数在性别上是否有差异,并通过Pearson检验分析其与身高的相关性;通过CT影像进行解剖形态学观察,进而分析胫骨远端髓腔的大小和形态、上下截骨面髓腔的大小及相对位置关系.结果 L1为(339.0±22.2)mm,L2为(210.0±20.2)mm,L4为(27.0±4.3)mm,L5为(56.5±15.0)mm,L6为(3.6±0.6)mm,D1为(10.2±1.6)mm,D2为(22.2±2.5)mm,D3为(18.1±2.5)mm,∠α为32.8±24.7°(忽略成角方向).L1、L2、L6、D1、D2、D3均与身高呈正相关(r=0.212~0.793,P值均<0.05),且男性明显大于女性(P值均<0.05);保留下胫腓韧带残留的最短胫骨长度占胫骨长度百分比(S1)与身高呈负相关(r=-0.199,P<0.05),男女之间差异无统计学意义(P>0.05);L4、L5、∠α、胫骨髓腔最狭窄部与胫骨的位置比例(S2)相对固定,与身高无相关性,且男女之间差异无统计学意义(P值均>0.05).当胫骨远端残留长度≤4 cm时,胫骨远端髓腔为近端窄小而远端宽大的"反漏斗"形状;胫骨机械轴相对于胫骨下关节面上4 cm处截面的髓腔解剖轴CT冠状面上偏内约18.5% ±6.5%的位置,矢状面上偏后约34.5% ±4.7%的位置,故假体远端柄位置设计应更贴合内后侧皮质.结论 胫骨有其固有的CT影像形态特�Objective To analyze the anatomical data of southwestern region and to investigate the morphological analysis of normal distal segment tibia, as the basis for the design of new diaphysis prosthesis for limit bone defects of distal tibial. Methods A retrospective study in West China Hospital of Sichuan University from January 2014 to October 2017 was carried out. One hundred and seven CT data of normal tibia were gathered, including 57 males and 50 females with the age of 20-40(29. 8 ± 5. 2) years old. The relevant anatomical data were measured by Mimics software. It included the length between upper and lower articular surface(L1), the length from upper articular surface to the upper margin of isthmus(L2) , the length of the shortest tibial length that could retain the distal tibiofibular ligament ( L4 ) , the length on the narrow segment(L5),the mean thickness of the thinnest cortex at the narrowest part of isthmus(L6), the diameter of the narrowest part of isthmus(D1) ,the thickness of the thinnest cortex at the narrowest part of isthmus, the major and minor axes of the most suitable ellipse for the medullary cavity above the distal tibial articular surface 4 cm ( D2 and D3 ) , the angle between D2 and coronal axis (∠α) and so on. Two independent sample t-tests were used to analyze whether the above parameters were different in gender, and&nbsp;their correlation with height was analyzed by Pearson test; anatomical observation was performed by CT images. The size and shape of the medullary cavity in the distal segment of the tibia and the size and relative position of the medullary cavity in the upper and lower osteotomies were analyzed. Results L1 was (339.0 ±22.2) mm, L2 was (210.0 ±20.2) mm, L4 was(27.0 ±4.3)mm, L5 was(56.5 ±15.0)mm, L6 was(3. 6 ± 0. 6) mm, D1 was(10. 2 ± 1. 6) mm, D2 and D3 were(22. 2 ± 2. 5) mm and(18. 1 ± 2. 5)mm,∠α was 32. 8 ± 24. 7°. L1, L2, L6, D1, D2 and D3 had positive correlation with height(r=0.212-0. 793, all P values <0. 05), and males were significantly larger th

关 键 词：胫骨 体层摄影术 螺旋计算机 骨缺损 胫骨假体 影像解剖 

分 类 号：R687.3[医药卫生—骨科学]