股骨远端三维模拟截骨在膝关节置换中的应用  

Application of three-dimensional simulated osteotomy of the distal femur in total knee arthroplasty

作　　者：王体惠 王旭 吴锦清 陈继良 王晓露 缪娟 Wang Tihui;Wang Xu;Wu Jinqing;Chen Jiliang;Wang Xiaolu;Miao Juan(Department of Joint Surgery,Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,Fujian Province,China)

机构地区：[1]福建医科大学附属闽东医院关节外科,福建省福安市355000

出　　处：《中国组织工程研究》2024年第6期905-910,共6页Chinese Journal of Tissue Engineering Research

基　　金：福建省自然科学基金经费支持(2019J01618),项目负责人:王体惠。

摘　　要：背景:有研究显示不同种族、性别的股骨远端几何形态学差异较大,中国南方身材矮小的女性患者较多,因此术中常发生进口膝关节假体悬出或覆盖不足的现象。目的:通过对股骨远端骨骼三维重建模拟膝关节置换股骨侧截骨并与常用进口关节假体匹配,探讨中国南方女性的股骨远端骨骼特点并比较与进口关节假体的差异。方法:2021年1-12月选择120例女性志愿者行膝关节CT薄层扫描。将扫描图像以Dicom格式导入Mimics 20.0软件进行三维重建,然后导入Magic 22.0软件模拟后交叉韧带保留型人工全膝关节置换术中测量截骨并与进口关节假体进行匹配研究。结果与结论:(1)功能性股骨前后径(functional anteroposterior dimension,fAP)与Persona假体匹配,总的悬出率为25%(30/120),f AP≤47 mm组比其余各组更容易出现假体悬出(P<0.05)。Triathlon假体覆盖不良率为12.5%(15/120),fAP﹥53 mm组比f AP≤53 mm组更容易出现覆盖不良(P<0.05)。(2)股骨髁间宽度与Triathlon假体匹配,总的覆盖不良率为27.5%(33/120),因此fAP≤47 mm组比其余各组更容易出现股骨远端中央区骨面覆盖不良(P<0.05)。Journey II假体悬出率为21.6%(26/120),fAP﹥53 mm组比fAP≤53 mm组更容易出现假体悬出(P<0.05)。(3)与股骨前端内外径长度值差异最大的是Journey II CR假体,容易在股骨假体前外侧悬出;与股骨后端内外径长度值差异最大的是Persona CR假体,容易在假体后内侧覆盖不良。建议增设fAP≤47 mm股骨假体的窄号,增设髁间宽度的宽、窄号,同时优化股骨假体前外侧弧形设计以提高后交叉韧带保留型膝关节假体的匹配性。BACKGROUND:Studies have shown that there are significant differences in the geometric morphology of the distal femur of different races and genders,and there are more short female patients in southern China,so the phenomenon of overhanging or insufficient coverage of imported knee prostheses often occurs during surgery.OBJECTIVE:To investigate the characteristics of distal femur bones in southern Chinese women and compare them with imported joint prostheses by simulating the three-dimensional reconstruction of the distal femur bone and matching the femoral side after osteotomy with common imported joint prostheses.METHODS:From January to December 2021,120 female volunteers underwent a CT scan of knee joints.The images were imported into Mimics 20.0 software in Dicom format for three-dimensional reconstruction and then imported into Magic 22.0 software to simulate osteotomy by posterior cruciate ligament preserved total knee arthroplasty and to conduct a matching study with a normal imported joint prosthesis.RESULTS AND CONCLUSION:(1)The functional anteroposterior dimension(fAP)of the distal femur and Persona matched prosthesis had a total overhang rate of 25%(30/120).The fAP≤47 mm group had an overhang than the other groups(P<0.05).The poor coverage rate of Triathlon prosthesis was 12.5%(15/120),and poor coverage was more likely in fAP>53 mm group than in fAP≤53 mm group(P<0.05).(2)The total poor coverage rate of femoral intercondylar width matching with Triathlon prosthesis was 27.5%(33/120).Therefore,the poor coverage rate of bone surface in the central region of the distal femur was more likely in the fAP≤47 mm group than in other groups(P<0.05).The overhang rate of Journey II was 21.6%(26/120),and the overhang rate was higher in the fAP>53 mm group than in the fAP≤53 mm group(P<0.05).(3)Journey II CR prosthesis had the largest difference with the length of the anterior mediolateral diameter of the femur,which was easy to hang out on the anterolateral side of the femoral prosthesis.The Persona CR prost

关 键 词：中国 女性 膝关节骨骼形态 全膝关节置换 后交叉韧带保留型假体 三维成像 体层摄影术 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R684.3