胫骨近端纵横比和胫骨假体匹配度的相关研究进展  

Proximal tibial aspect ratio and matching of tibial component in total knee arthroplasty:a narrative review

作　　者：曹东东 刘爱峰[1] 吾米提·塔西 纪能能 王平[1] 张宇[1] Cao Dongdong;Liu Aifeng;Tashi Umiti;Ji Nengneng;Wang Ping;Zhang Yu(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院、国家中医针灸临床医学研究中心,天津300381

出　　处：《中华外科杂志》2023年第8期727-732,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81873316);天津市卫生计生委、天津市中医药管理局中医、中西医结合科研课题(2017118)。

摘　　要：胫骨近端纵横比(PTAR)与年龄、疾病状态、截骨参数密切相关,且存在与性别、种族因素无关的巨大个体变异,因此,胫骨假体不匹配是全膝关节置换术(TKA)中的常见问题。尽管各种常见胫骨假体系统的覆盖率均可达80%以上,但其精确匹配率一般低于50%。对称型假体很难避免前后向不匹配,且在内侧优势型或PTAR较小的胫骨平台表面更易出现假体内旋;而解剖型假体在对称型或外侧优势型的胫骨平台表面则存在明显前内侧悬突趋势。未来的研究应更多聚焦于胫骨近端形态学的个体间变异规律,更科学地量化定义胫骨近端各分区关键形态参数的“理想匹配”安全范围,以及如何以更少的假体型号实现更大范围的胫骨假体“理想匹配”。随着增材制造与数字骨科技术的飞速发展,个体化定制有望成为TKA假体匹配领域新的突破点。Proximal tibial aspect ratio(PTAR)is closely related to age,disease status and cutting parameters with considerable inter-individual variation independent of gender and race,nevertheless the aspect ratio of tibial components from different manufacturers remains relatively constant from smallest to largest size.As a result,component mismatching is an unavoidable dilemma during tibia preparation in total knee arthroplasty(TKA).Various prosthesis systems all can achieve more than 80%coverage on proximal tibia,whereas their optimal fit rates are generally not more than 50%.It is difficult for symmetrical components to avoid anteroposterior mismatch,internal malrotation tends to occur when maximum coverage is pursued on the resected surface with a medial dominant plateau or lower PTAR.Although it is easier to achieve a balance of rotation and coverage with anatomical components,significant anteromedial overhang tends to appear on the resected surface with a symmetrical or lateral dominant plateau.Further researches should focus on the law of inter-individual variability of proximal tibial morphology,the quantitative definition of“ideal matching”safety zone of key morphological parameters on different areas of proximal tibia and the methodology of realizing"ideal matching"in the majority patients with the least amount of component sizes.In addition,with the rapid development of additive manufacturing and digital orthopedic technology,individual customized implant is expected to become a breakthrough point in the field of TKA component fitting.

关 键 词：关节成形术 置换 膝 假体设计 形态学 胫骨近端 

分 类 号：R687.3[医药卫生—骨科学]