国人正常胫骨近端线性参数测量及特性分析

目的获取国人正常胫骨近端不同截面各线性参数正常参考值,为国产人工膝关节假体设计以及全膝关节置换术临床操作提供参考依据。方法选取61例(100膝,男65膝,女35膝)国人正常膝关节,年龄1781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,测量不同截面的相关线性参数。结果测得截面前后径为(48.9±3.1)mm,横径为(75.2±4.5)mm,前后径与横径的比值为0.650±0.034;经过横轴距离内外侧平台边缘10%、20%、30%点的前后距离平均值分别为36.1、46.6、51.2、37.1、44.1和47.6mm;分析得出胫骨截面前后径、横径与前后径的比值在不同截骨高度和不同性别中的差异均有统计学意义。结论国人胫骨近端的几何形态与解剖特点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全膝关节置换手术时应该注意到性别的差异。     

汉族与蒙古族胫骨近端部分数字化解剖形态的测量与对比

 背景：在进行国人膝关节假体设计以及全膝关节置换时,不仅要考虑到国人胫骨近端解剖特点和几何形态上的差异,同时也还应该注意不同种族间的差异性。目的：通过对汉族与蒙古族胫骨近端的CT断层扫描及三维重建测量,对比其在蒙、汉族之间的解剖形态学差异,为全膝关节置换的假体选择提供数据参考。方法：收集于关节外科就诊的患者60例,其中汉族组、蒙古族组各30例,各组均男15例,女15例,年龄(36.00±7.22)岁。16排螺旋CT扫描仪(美国GE公司Lightspeed 16)对其进行螺旋扫描,层厚0.625 mm,扫描图像以DICOM格式导出存盘。再利用Mimics 15.0三维重建软件进行数字化三维重建测量。分别对胫骨平台宽、胫骨平台内侧前后径和外侧前后径进行测量,以观察其在性别、侧别和民族间是否具有差异性。结果与结论：以上各指标值在左、右侧别间差异均无显著性意义(P > 0.05)。胫骨平台宽、胫骨平台内侧前后径和胫骨平台外侧前后径在男、女性别间和汉族、蒙古族之间差异均存在显著性意义(P < 0.05),具体表现在：①胫骨近端的形态学测量参数无论汉族组还是蒙古族组在性别间差异均存在显著性意义,且男性各均值大于女性。②部分参数指标在汉族与蒙古族间存在着一定的差异性,提示在施行人工全关节置换时,应根据国人形态特征、性别、民族、地区等差异正确地选择并放置假体。③数字化三维重建技术和个体化设计可以针对不同人群选择适合的假体,从而确保患者在全膝关节置换后获得良好的修复效果。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

胫骨近端的形态学测量与膝关节置换

背景：胫骨近端为膝关节假体构成的下半部分,胫骨近端是膝关节假体放置的底部位。 目的：评价胫骨近端的形态测量在临床上膝关节置换中的重要性。 方法：以 “膝关节;假体;置换”为中文关键词,以“Knee; Prosthesis; replacement” 为英文关键词。采用计算机检索1995-01/2011-10有关磁共振图像测量在临床上膝关节置换中假体旋转对线中应用的文章。 结果与结论：胫骨近端的形态测量即胫骨近端的三维有限元模型、相关参数及角度、生物力学研究与膝关节假体选择及设计有着重要相关性。胫骨近端的形态测量有二维和三维测量,以三维测量法精确,测量胫骨平台宽和倾斜角度、胫骨内外侧平台前后径,所测量的数据在临床上均有应用意义。胫骨近端是膝关节假体放置的底位置,而胫骨近端的三维模型与假体模型底部行模拟对接,提高手术的成功。     

胫骨近端后侧数字化三维形态学测量及临床意义

目的　研究胫骨近端后侧数字化形态学测量的方法,探讨其对胫骨后侧平台骨折诊疗的意义。  方法　对60例健康成人胫骨干燥标本进行CT扫描,图像导入Mimics 10.01软件建立数字化三维模型,测量相关解剖参数,分析其分布规律与相关关系。  结果　后侧正中高度（8.46±1.62）mm,后内侧高度（12.27±1.93）mm,后内侧斜坡长度（14.71±2.27）mm,后内侧平台斜坡角（132.02±11.62）°,后内侧斜坡骨干角（147.28±10.72）°,后外侧高度（11.31±1.74）mm,后外侧斜坡长度（14.45±2.26）mm,后外侧平台斜坡角（124.01±9.81）°,后外侧斜坡骨干角（141.88±9.09）°,所有测量参数双侧差异无统计学意义（P＞0.05）。后正中高度、后外侧高度和后外侧斜坡长度与胫骨全长具有相关性（P＜0.01）。   结论　本研究建立的胫骨近端数字化三维模型仿真度高,解剖参数测量结果精确度高,能为胫骨后侧平台骨折临床治疗和内固定物设计提供解剖学依据。     

股骨近端解剖参数的自动化三维测量

目的基于解剖标志建立股骨三维坐标系,实现股骨近端解剖参数的自动化测量,辅助术前规划及个性化股骨柄设计。方法自主研发专用于股骨解剖测量的Femeter软件,可读取显示股骨STL模型,手工选取目标解剖标志点。运用半球形搜索迭代方法实现髓腔快速三维建模,运用经典最小二乘拟合等算法实现股骨头半径、颈干角、前倾角等相关16个测量参数的自动计算。结果通过30例股骨STL模型进行测量实验,平均单次测量的算法执行时间为(0.95±0.16)s,9个解剖测量项的评定者内和评定者间可靠性较高(组内相关性系数为0.907~0.999)。结论 Femeter软件的自动建模和测量算法执行速度较快,测量可重复性较好,操作简易,适用于临床。自动化三维股骨近端解剖测量可为人工全髋关节置换术前规划、股骨柄选择和个性化股骨柄设计提供可靠数据。     

股骨近端内侧解剖学参数测量及临床意义

目的 ：通过对成人股骨标本近端,尤其是股骨颈内侧区解剖参数的测量,为设计出适合国人股骨近端内侧解剖特点的内固定物提供参考资料。方法 ：选用正常国人股骨干标本,通过人工直接测量和基于X线的AutoCAD软件测量2种方法。测量指标包括小转子纵径、小转子横径、小转子高度、股骨小转子方位角α、股骨颈下缘线长度、股骨颈放散角β、γ、δ、股骨长度、股骨头直径、股骨头长径、头颈比例等解剖学参数。结果 ：直接测量和基于X线的AutoCAD软件测量结果无差异。股骨长度（38.65±2.25）cm;股骨头直径（4.27±0.38）cm;股骨头长径（3.35±0.48）cm;股骨小转子方位角α 35.00°±6.00°;小转子纵径（2.39±0.33）cm;小转子横径（1.46±0.24）cm;小转子高度（1.37±0.20）cm;股骨颈下缘线长度（2.27±0.43）cm;头颈比例（1.39±0.11）;股骨颈近端放散角β近（90.29±13.94）°、γ近（45.38±7.95）°、δ近（44.34±7.35）°;股骨颈中份放散角β中（76.27±8.85）°、γ中（52.70±7.43）°、δ中（51...     

保留前后交叉韧带人工全膝关节假体的胫骨近端解剖测量

背景：目前使用的保留前后叉韧带的假体仍存在诸多问题。改良和设计保留前后交叉韧带膝关节假体相关的形态测量,特别是胫骨近端未曾见到过详细的报道和研究。 目的：通过对正常膝关节三维数字化模型进行相关的胫骨近端形态学的分析,从而为改良和设计保留前后交叉韧带人工全膝关节假体提供参考。 方法：40例正常志愿者进行膝关节的CT及MRI扫描,然后将膝关节CT、MRI断层影像数据导入Mimics 10.01进行图像分割与三维重建,重建出完整的膝关节三维实体数字化模型后再导入Geomagic Studio 11,在膝关节模型上测量前后交叉韧带在胫骨近端解剖参数,模拟截骨后测量胫骨近端截骨面的解剖参数。 结果与结论：前后交叉韧带总的宽度为(14.94±2.56) mm,性别间比较提示男性需适当增加横向的截骨宽度以避免损伤前后交叉韧带。胫骨髁间棘顶部的长度为(8.02±1.03) mm,底部的长度为(15.19± 1.71) mm,截骨后高度(9.13±0.88) mm,而且此梯形结构位于前后径48%-82%。胫骨截骨面内侧的内外径短于外侧的内外径,内侧前后径大于外侧的前后径,因而保留前后交叉韧带的假体更需要非对称性的设计。     

膝关节置换术后长期胫骨近端力学性能的预测

目的 分 析 膝 关 节 单 髁 置 换 术 ( unicompartmental knee arthroplasty, UKA) 和 全 膝 置 换 术 ( total knee arthroplasty, TKA)后长期胫骨近端力学性能的变化,探究 UKA 和 TKA 的失效原因。 方法 建立健康、UKA、TKA胫骨近端有限元模型,利用 Wolff 骨重建理论结合有限元法预测胫骨近端的密度分布和应力分布。 结果 UKA 外侧踝平均应力基本不变,但呈增大趋势,平均密度增加 2%,内侧踝平均密度减小 13%,平均应力均减少 11%。 TKA外侧踝平均密度减少 1. 5%,平均应力减少 14%,内侧踝平均密度减少 1. 4%,平均应力减少 19%,假体末端平均密度增加 10%,平均应力增加 15%。 结论 UKA、TKA 假体的植入会造成应力遮挡现象,可能是产生术后假体松动的主要原因。 TKA 假体末端应力增大,可能导致 TKA 的失效。 UKA 非置换侧平均应力随着骨重建的进行不断增大,可能就导致 UKA 中远期对侧骨关节炎恶化。 研究结果可以为降低 UKA、TKA 并发症发生概率提供数据支持。     

卵泡刺激素受体基因多态性与西北地区汉族妇女卵巢反应性的关系

目的探讨卵泡刺激素受体基因（FSHR）-29（rsl394205）和Asn680Ser（rs6166）位点多态性与西北地区汉族妇女控制性超排卵（COH）中卵巢反应性的关系。方法采用限制性酶切技术对卵巢高反应患者45例,卵巢低反应患者27例和卵巢正常反应的对照69例的FSHR基因-29（rsl394205）位点和第10号外显子Asn680Ser（rs6166）位点进行分型,并通过Fisher’s精确检验的方法分析基因型和等位基因的分布频率。结果①FSHR基因-29位点基因型、等位基因频率在三组间分布无差异。②Asn680Ser位点基因型、等位基因频率在卵巢高反应组与正常对照组间无统计学差异（P〉0．05）;Ser／Ser基因型频率在卵巢低反应中占40．7％,与正常对照组差异有统计学意义（P〈0．01）;携带G等位基因者发生卵巢低反应的风险增加（OR=2．37,％95CI=[1．25-4．52]）。结论FSHRAsn680Ser位基因多态性与西北地区汉族妇女COH中的卵巢低反应相关。当Asn680Ser（rs6166）位点G等位基因的存在增加卵巢低反应的风险。     

SA基因与中国汉族人群高血压病的关系

目的 探讨SA基因座是否与中国汉族人群高血压病连锁,以及SA基因多态性与中国汉族人群高血压病的关系。方法 应用MF－PCR－SSCP技术研究SA基因座微卫星的频率分布特征;以SA基因座微卫星为遗传标记,通过状态一致性受累同胞对连锁分析方法探讨SA基因座是否与高血压病连锁,运用PCR－SSCP－银染技术筛查SA基因变异体,再经测序证实,然后通过关联研究明确这种变异是否与高血压病有关。结果 （1）D16S3046、D16S3136和D16S3068多态信息量（PIC）分别为0．86、0．82和0．80,杂合度（H）分别为0．88,0．71和0．77,表明中国汉族人群SA基因座微卫星的频率分布具有高度多态性;（2）SA基因座与中国汉族人群高血压病无链关系,微卫星D16S3046、D16S3136和D16S3068连锁分析t值分别为0．972、0．622和0．236,P值分别为0．384、0．543和0．871;（3）SA基因座存在C→置换,但各基因型和等位基因的频率分布在有高血压病家族史的高血压病患者和无高血压病家族史的血压正常人之间差异无显著性,前者χ^2=0．296,P＞0．05。结论 SA基因与中国汉族人群高血压病无关,SA基因可能不是中国汉族人群高血压病的易感基因。     

Stereological and serial section analysis of chondrocytic enlargement in the proximal tibial growth plate of the rat

Background: It has been suggested that within the growth plate, the final volume and shape of hypertrophic chondrocytes are important variables in determining the rate of longitudinal bone growth. To better understand the organization and regulation of chondrocytic hypertrophy as related to longitudinal bone growth, the beginning and end, and the location and magnitude of chondrocytic volume and shape changes during the hypertrophic process were defined in the proximal tibial growth plate of 35-day-old rats. Methods: In this study we used two different approaches, a stereological analysis of chondrocytes in unbiasedly defined, narrow growth plate strata, and a serial section reconstruction and measurement of individual cells. In both experiments chondrocytes were preserved using optimal chemical fixation. Proliferating chondrocytes were identified using bromodeoxyruidine labelling, and the rat of longitudinal bone growth was determined using oxytetracycline labelling. Results: In both studies, immediately following cell division in the proliferative zone, chondrocytic volume gradually increased toward the midpoint of the growth plate. During this phase of about 30 hours, approximately 20% of the final cell volume was obtained. During the following 20 hours the remaining 80% was acquired. The estimated rate of cell volume increased changed from approximately 50 μm³/hr during the first 30 hours to about 800 μm³/hr during the last 20 hours. The increase in cell volume resulted in an increase in both the vertical and the horizontal chondrocytic diameters. Cell parameters did not change during the final five hours of the maturation process. Conclusions: In this study we demonstrated that chondrocytic enlargement starts immediately following cell division in the proliferative zone, and that chondrocytic enlargement consists of two morphologically distinguishable phases. The transition point between the first and the second phase of chondrocytic enlargement corresponded with the junction between the proliferative zone and the maturation zone. © 1994 Wiley-Liss, Inc.     

胫骨平台线性几何参数在CT三维重建中的测量及其意义

目的　通过CT三维重建技术构建胫骨平台三维模型,准确测定胫骨平台线性几何参数,探讨CT三维重建技术在胫骨平台测量中的应用及临床意义。 方法 随机抽取病房、门诊患者（膝关节正常,且胫骨未受累）及健康志愿者49例,并分别按性别进行分组。通过CT三维重建技术测量胫骨平台相应线性几何参数,包括参数：胫骨平台宽、胫骨内侧平台宽、胫骨内侧平台前后径、胫骨外侧平台宽和胫骨外侧平台前后径。 结果 （1）男性胫骨平台各项线性指标均明显大于女性（P<0.01）;（2）外侧平台比内侧平台宽,前后径小于内侧平台（P<0.05）;（3）胫骨平台宽与内外侧胫骨平台前后径存在着正相关关系（P<0.05）。 结论 CT三维重建技术对胫骨平台线性几何参数的测量,能为国人膝关节假体设计改进提供一定的参考。     

掌骨,近节指骨骨髓腔的测量及其意义

目的 :测量掌、指骨骨髓腔长度 ,观察髓腔形状及变化 ,为掌指关节假体的设计及改进提供参考数据。方法 :2 0只手标本随机分为两组。 10只手从干骺端开始每隔 10mm进行横切 ,测量髓腔的冠状径及矢状径 ;其余纵切 ,测量髓腔长度及髓腔最狭窄处。拍摄 2 0只手标本X光片。测量Swanson假体柄及绞链区长度及宽度。结果 :掌骨骨髓腔形状男女及左右手无差别 ,髓腔长度大约为其全长的 3 /5 ,髓腔的狭窄段在全长中点近侧约 5～ 10mm处。指骨髓腔呈“喇叭型” ,长度同指骨无明显的比例关系。X光片测量结果基本同实际解剖测量相同。Swanson假体两端柄长度约为髓腔长度的 2 /3。绞链区长度稍小于1/2干骺端至掌骨头长度。结论 :掌指骨髓腔在中间较窄 ,两侧较宽 ,存在约 5～ 10mm的狭窄段。中间段髓腔形状五指各不相同。为设计国人掌指关节假体及改进Swanson硅胶假体提供参考数据 ,另外对于选择骨折内固定物及手术操作亦有指导意义     

腓骨高位截骨术对胫骨平台的生物力学分析

目的:采用三维有限元方法分析腓骨高位截骨对胫骨平台造成的生物力学改变,为腓骨高位截骨在伴有内翻畸形 的膝关节炎中的应用提供生物力学数据参考。方法:根据一例健康志愿者的CT数据,采用Mimics、Geomagic Studio2013 以及Abaqus6.13软件建立个体化的膝关节有限元模型,通过对模型设定边界条件、加载材料属性、载荷设置以及模拟腓骨 高位截骨术,计算腓骨高位截骨术前后胫骨平台的不同截面上任意节点的应力大小。结果:经手术去除腓骨的支撑后,内 侧胫骨平台的应力值变化情况不一致,内部的应力降低,中部的不变,外部的增大。而外侧胫骨平台的应力值均增加,且 其内部的应力值最大。整个胫骨平台上应力呈现往中间集中的态势。结论:腓骨高位截骨术有助于减小胫骨平台内侧的 应力,从而达到缓解膝关节炎病人的疼痛及活动不便的症状。由于术后应力的重新分布,故该术式的长期疗效及适应症 等仍需观察。     

The results of patellar stainless steel wire extensor mechanism reconstruction in proximal tibial tumour excision mega-prosthesis surgeries for proximal tibial sarcomas

BackgroundExtensor mechanism function after a proximal tibial tumour excision is the major determining factor for the limb function. However, problems of extensor lag, delayed healing and poor functional outcomes exist with the previous methods of its reconstruction. We describe a novel technique of using a patellar stainless steel (SS) wire to reconstruct the extensor apparatus of the knee in non-porous coated implants and examine the functional outcome and associated complications.MethodsThis was a retrospective analytical interventional study. Twenty-six patients operated between 2011 and 2019 were included. Extensor lag measured at 6 months and 12 months postoperative, total range of motion at 12 months and Musculoskeletal Tumor Society (MSTS) score at the final visit were retrieved. Complications that occurred during the follow up period were noted. Patellar position was measured using comparative patellar-position-ratio.ResultsMean extensor lag at 6 months was 18.5° which improved to 8.7° at 12 months. Patellar malposition and deep infection were found to be the causes of poor functional outcome. A patellar-position-ratio between 0.9 and 1.1 led to a well-functioning extensor apparatus. Four patients underwent above-knee amputations. Deep infection and amputations reduced the MSTS score. An SS wire give way after 6 months did not affect the extensor power. A medial gastrocnemius flap reduced the infection rates.ConclusionPatellar SS wiring is an effective technique for reconstructing the knee extensor apparatus following a proximal tibial tumour excision mega-prosthesis. Proper position of the SS wire prevents wire-related complications. For a well-functioning extensor apparatus, use of a gastrocnemius flap cover intra-operatively is pertinent along with lack of infection for a pain-free, stable and mobile limb.     

Three-dimensional image registration of MR proximal femur images for the analysis of trabecular bone parameters

This study investigated the feasibility of automatic image registration of MR high-spatial resolution proximal femur trabecular bone images as well as the effects of gray-level interpolation and volume of interest (VOI) misalignment on MR-derived trabecular bone structure parameters. For six subjects in a short-term study, a baseline scan and a follow-up scan of the proximal femur were acquired on the same day. For ten subjects in a long-term study, a follow-up scan of the proximal femur was acquired 1 year after the baseline. An automatic image registration technique, based on mutual information, utilized a baseline and a follow-up scan to compute transform parameters that aligned the two images. In the short-term study, these parameters were subsequently used to transform the follow-up image with three different gray-level interpolators. Nearest-neighbor interpolation and B-spline approximation did not significantly alter bone parameters, while linear interpolation significantly modified bone parameters (p<0.01). Improvement in image alignment due to the automatic registration for the long-term and short-term study was determined by inspecting difference images and 3D renderings. This work demonstrates the first application of automatic registration, without prior segmentation, of high-spatial resolution trabecular bone MR images of the proximal femur. Additionally, inherent heterogeneity in trabecular bone structure and imprecise positioning of the VOI along the slice (anterior-posterior) direction resulted in significant changes in bone parameters (p<0.01). Results suggest that automatic mutual information registration using B-spline approximation or nearest neighbor gray-level interpolation to transform the final image ensures VOI alignment between baseline and follow-up images and does not compromise the integrity of MR-derived trabecular bone parameters used in this study.     

中国福建东南部成人女性胫骨近端表面及断面几何参数三维数字化测量及临床意义

BACKGROUND: Artificial knee joint replacement is the main surgical method for the treatment of severe knee joint deformation, but due to the limited existing knee prosthesis type. The stature of Fujian population in southeast China was shorter than that of the north. The size of artificial knee joint usually did not fit for patients in clinic. The substitution effect was poor.     

有限元法分析全膝关节置换对胫骨近端骨重建的影响

BACKGROUND: The studies about biomechanics of total knee arthroplasty were more, but the research on finite element analysis of the effect of total knee arthroplasty on proximal tibial reconstruction was not much.