国人正常胫骨近端几何形态学的初步研究

目的探讨国人正常胫骨近端截面线性参数测量新方法，为国产人工膝关节假体设计以及全膝关节置换术（TKA）临床操作提供参考依据。方法选取82例／135膝（男85膝，女50膝）国人正常膝关节，年龄19～82岁，平均47．2岁；分别按照性别、年龄和侧别进行分组；利用原始CT扫描图像资料重建膝关节，并在工作平台上对胫骨进行旋转、切割，测量计算不同截骨高度各截面的相关线性参数。结果测得所有受试者胫骨各截面的横径平均值为（75．03±4．88）mm；距离内外侧平台边缘向中心10％、20％、30％、40％及50％点的前后径分别为36．14、46．41、51．04、49．80、48．41、48．63、47．41、44．14、36．96mm；截面纵横比平均值为0．678；并分析得出胫骨截面横径及各百分点的前后径在不同性别间差异有显著统计学意义，而在年龄组和侧别组则无统计学意义。结论国人正常胫骨近端的几何形态同西方人有明显的区别；应用西方人设计的胫骨平台假体要考虑到国人的特点和性别差异；设计国人膝关节假体以及进行TKA手术时应该注意到性别的差异。

Morphologic research of proximal tibia in normal Chinese

Objective To research a new approach of measuring the normal proximal tibia linear parameters in Chinese, and provide reference for improving the design of domestic knee prosthesis and clinic technology of TKA. Methods Choose 8：2 normal Chinese/ 135 knees （ include 85 male and 50 female knees） , with average age of 47.2 years （range from 19 to 82 year-old） , then divided them into groups according to the age, side of the knee and gender. Utilized original CT image data to set up the threedimensional model of Chinese normal knees and gain the linear parameters of different resection surfaces on the work station. The midpoint and points 10, 20, 30, and 40% from the medial and lateral peripheries were then calculated. Results The average medial-lateral length of all the proximal tibia sections was （75.03 ±4. 88）mm. The average anteroposterior medial 10, 20, 30, and 40% dimensions were 36. 14, 46.41, 51.04 and 49. 80 ram, respectively. The average anteroposterior lateral 10, 20, 30, and 40% dimensions were 36. 96, 44. 14, 47.41 and 48. 63 mm, respectively. The midpoint dimension was 48.41 ram. The mean ratio of AP/ ML was 0. 678. It was confirmed through statistical analysis that the mediallateral length and all related percentage dimensions showed statistical significance among different gender. Conclusions The geometry and anatomy of proximal tibia in Chinese showed significant difference compared with westerners. The characteristics and the gender difference should be considered when we use the tibial plateau prosthesis designed by the westerners. The sex difference should also be taken into account when we design the domestic tibial plateau prosthesis and total knee arthroplasty.