股骨远端三维截骨测量及假体形态的性别差异分析

目的探讨在三维螺旋CT重建下，男女性股骨远端的解剖特点对于关节表面假体形态的不同要求。方法80侧正常成人膝关节，男、女各40侧，年龄18—72岁，行三维螺旋CT下0．625mm薄层扫描，在GeomagicStudio三维图像处理系统上进行模拟截骨，测量股骨经上髁轴线宽度、内外侧髁高度及内外侧滑车前突距离，比较各测量值性别间的差异。结果男女性经上髁轴线宽度、外侧髁高度及内侧髁高度间的差异均有统计学意义（P〈0．01），男性各值均大于女性。股骨远端横径与纵径的比值亦为男性大于女性（P〈0．01），男性股骨内、外侧滑车前突距离均大于女性，均值差分别为1．05mm和0．7mm，均有统计学差异（P〈0．01）。结论男女性之间股骨髁形态存在一定差别，股骨远端关节面假体形态的设计应该性别差异化，使假体与截骨面更好的吻合，以提高全膝关节置换术的手术效果。

3-Dimensional measurement of resection heights and sex difference in the design of of the distal femoral prosthesis

Objective To study the differences in the design of the femoral prosthesis between men and women with 3-dimensional CT. Methods 80 normal knees of Chinese adults （ male 40, female 40, age 18-72 years） were examined by MSCT scanning with 0. 625 mm thin gap, three-dimensional reconstruction of the distal femur was performed on Geomagic Studio 3-dimensional imaging system. Then, the width of the femur through the transepicondylar line, the height of the medial condylar, together with the lateral condylar were measured. The distance between anterior processes of the medial and lateral trochleas were calculated by stimulating osteotomy. All the data was grouped and a comparison was preformed by gender. Results The parameters of the male femur were bigger than those of the women, including the width of the femur through the transepicondylar line, the height of the condylars and the anterior process of trochleas（ P 〈 0. 001 ）. Moreover, there was a significant difference in the ratio of the mediallateral diameter and anteroposterior diameter between genders. Conclusions There were certain anatomy differences in the distal femurs between male and female. Gender difference should be considered in the design of the femoral prosthesis in order to achieve a satisfactory outcome in total knee arthoplasty.