胫骨近端几何形态分析与再置换胫骨组件的设计研究
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Proximal tibia morphologic analysis for the design of revision tibial component
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    摘要:

    目的良好的胫骨组件与胫骨截骨平面配合,可提高人工关节组件的稳定性,同时可避免组件沉陷或松脱。目前国内市售的人工关节多由欧美进口,这些胫骨组件尺寸不符合国人的需求,在膝关节置换手术时,胫骨的外形轮廓会随着骨切除不同深度而改变,使得再置换胫骨组件与截骨平面较难有良好的覆盖。该研究将台湾人胫骨近端的几何形状应用于胫骨基座与胫骨填补块(tibial augmentation)设计的参考,以提高胫骨组件与截骨平面的涵盖率。方法利用50例退化性关节炎患者之病肢,通过计算机断层扫描重建胫骨近端3D模型,以取得胫骨外型参数。测量胫骨平台下方4、7、10、13、16mm处的5个截骨平面。测量参数包含截骨平面的前后侧(AP)长度,内外侧(ML)宽度,以及前外侧(AL)、后外侧(PL)、前内侧(AM)与后内侧(PM)之圆弧半径。结果结果显示平均AP47.4mm(40.4-52.9mm)、ML69.0mm(59.6-79.1mm)、AL30.0mm(18-38mm)、PL20.0mm(10-25mm)、AM28.7mm(18-36mm)、PM17.9mm(11-23mm)。将测量结果与市售的胫骨之间尺寸进行分析,进口假体PFCSigma与Zimmer Nexgen所提供的尺寸较适合国人。结论身高与AP、ML尺寸呈高相关性,而国人体型较欧美矮小,人种间身高上的差异,可能就是导致市售假体与国人胫骨截面尺寸不合的原因。通过测量资料,针对国人规划5款假体尺寸,应可提高涵盖率,减少尺寸不合导致植入物沉陷的发生机率。

    Abstract:

    Objective Good coverage of tibial component and proximal resected tibial surface can improve the strength of component fixation and thus avoid component subsidence and loosening. Most prostheses used in Taiwan are imported from USA or Europe. Such tibial components don’t have good coverage for Taiwanese in our previous study. Especially in revision knee surgery, the shape is varied in different cutting thicknesses of the tibia, which makes it more difficult to have a good coverage of revision tibial component and resection surface. The purpose of this study was to investigate the proximal tibial morphology of Taiwanese. The results can be applied for geometric designs of tibial baseplate and augmentation. Methods Fifty osteoarthritis knees were collected for analysis. Three-dimensional proximal tibia was constructed from Computed-Tomography slices for measuring morphologic data. Five cutting depths of 4, 7, 10, 13, and 16mm below tibial plateau were measured. The parameters included the dimensions of anteroposterior length (AP), mediolateral width (ML) of resected surface and four radii as anterolateral radius (AL), posterolateral radius (PL), anteromedial radius (AM), and posteromedial radius (PM). Results The results showed that mean AP was 47.4mm(40.4-52.9), mean ML was 69.0mm (59.6-79.1), AL was 30.0 mm (18-38), PL was 20.0 mm (10-25), AM was 28.7 mm (18- 36), and PM was 17.9mm (11-23). Conclusion Comparing the results with commercial tibial components, the imported implants of PFC sigma and Zimmer Nexgen could provide better coverage for Taiwanese. Body height and dimensions of AP and ML present high dependence, and American and European is relatively taller than Taiwanese. The factor of body height may highly influence the covering rate of tibial components. This study suggested 5 sizes of tibial components for Taiwanese. They can improve the rate of coverage, and reduce the rate of implant subsidence.

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李国宏,张宗维,黄昌弘,魏鸿文,郑诚功.胫骨近端几何形态分析与再置换胫骨组件的设计研究[J].医用生物力学,2007,22(4):334-338

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