中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (29): 4647-4651.doi: 10.12307/2023.664

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

X射线评价正常膝关节解剖学参数的性别及年龄差异

陈昌美1，2，曾宪春2，王荣品2，吴家红3   

  1. 贵州医科大学，1公共卫生与健康学院，3基础医学院，贵州省贵阳市   550025；2贵州省人民医院医学影像科，贵州省贵阳市   550002
  • 收稿日期:2022-08-01 接受日期:2022-09-19 出版日期:2023-10-18 发布日期:2022-12-02
  • 通讯作者: 吴家红，博士，教授，贵州医科大学基础医学院，贵州省贵阳市 550025
  • 作者简介:陈昌美，女，1993年生，贵州省铜仁市人，汉族，贵州医科大学在读硕士，主要从事疾病预防与控制方面的研究。
  • 基金资助:
    贵州省中医药管理局中医药、民族医药科学技术研究(QZYY-2020-018)，项目负责人：曾宪春

Sex and age differences in the anatomical parameters of normal knee joints evaluated by X-ray

Chen Changmei1, 2, Zeng Xianchun2, Wang Rongpin2, Wu Jiahong3   

  1. 1School of Public Health, 3School of Basic Medicine, Guizhou Medical University, Guiyang 550025, Guizhou Province, China; 2Department of Medical Imaging, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
  • Received:2022-08-01 Accepted:2022-09-19 Online:2023-10-18 Published:2022-12-02
  • Contact: Wu Jiahong, MD, Professor, School of Basic Medicine, Guizhou Medical University, Guiyang 550025, Guizhou Province, China
  • About author:Chen Changmei, Master candidate, School of Public Health, Guizhou Medical University, Guiyang 550025, Guizhou Province, China; Department of Medical Imaging, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
  • Supported by:
    The Traditional Chinese Medicine Administration Project of Guizhou Province, No. QZYY-2020-018 (to ZXC)

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摘要：


文题释义：

内侧胫骨平台后倾角：有3种测量方法，此次研究采用前皮质测量法。在膝关节X射线侧位片作距胫骨平台远端胫骨前皮质5，15 cm处两点的连线为前皮质线测量轴，内侧胫骨平台后倾角是前皮质线的垂线与胫骨平台所形成的夹角，维持前后交叉韧带的张力及膝关节稳定性，反映胫骨平台的倾斜度。
Insall-Salvati指数(IS指数)：是膝关节X射线侧位片上髌韧带长度与髌骨高度的比值，可用来判断髌骨位置的高低。

背景：全膝关节置换是有效治疗终末期膝关节骨关节炎的手段之一。而根据国外人群标准设计的置换假体应用到国内人群时，常出现假体不匹配等严重并发症，因此设计与国人相匹配的假体关节尤为迫切。而获知膝关节解剖学参数的正常值及其在不同性别、年龄及左右侧之间的差异可为置换假体的设计提供参照依据。
目的：探讨贵阳市人群双侧正常膝关节解剖学参数的正常值及其在不同年龄及性别间的差异。
方法：收集贵州省人民医院2015年1月至2021年1月行膝关节X射线片检查的18-45岁受试者13 666例，最终纳入正常膝关节且登记信息是贵阳市户口者2 978例，在其膝关节X射线正、侧位片上分别行解剖学参数(膝关节间隙、股骨髁横径、胫骨平台横径及Insall-Salvati指数等径线指标和股骨角、股骨胫骨角、胫骨角及内侧胫骨平台后倾角等角度指标)测量，并对比性别、年龄及双侧之间有无差异。
结果与结论：①在不同性别间，股骨角、股骨胫骨角、胫骨角、膝关节间隙、股骨髁横径、胫骨平台横径及Insall-Salvati指数相比差异均有显著性意义(P < 0.05)，女性股骨角及Insall-Salvati指数大于男性，余参数均为男性大；内侧胫骨平台后倾角无统计学差异(t=-0.64，P=0.523)；②在不同性别各年龄组间，男性股骨胫骨角、外侧膝关节间隙及女性股骨胫骨角、胫骨角、胫骨平台横径差异有显著性意义(P < 0.05)；③无论男性还是女性，36-45岁人群股骨胫骨角值均最大，同时女性胫骨角也最大；男性27-35岁人群外侧膝关节间隙为(7.78±0.72) mm，均大于其他组；女性18-26岁人群胫骨平台横径为(72.08±5.81) mm，较其他组大；余各参数无统计学差异(P > 0.05)；④在双侧膝关节间，股骨角、股骨胫骨角、胫骨角、内侧胫骨平台后倾角、膝关节间隙、股骨髁横径及Insall-Salvati指数差异均有显著性意义(P < 0.05)，除股骨角左侧较右侧大，其他参数均为右侧大；双膝胫骨角、胫骨平台横径相比无统计学差异(P > 0.05)；⑤提示获得的贵阳市人群正常膝关节解剖学参数正常值在性别、左右侧之间存在差异，而在不同性别各年龄组间大多数参数无差异，且大部分测量值与已有文献数据有差异，可为该地区正常膝关节数值及假体设计提供更准确的数据支撑。
https://orcid.org/0000-0003-3583-3806 (陈昌美) 

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

关键词: 正常人群, 膝关节, 骨关节炎, 解剖学参数, X射线片, 正常值

Abstract: BACKGROUND: Total knee arthroplasty is one of the effective treatments for end-stage knee osteoarthritis. The design of prosthetic joints to match the national population is particularly urgent because of the serious complications that often arise when replacement prostheses designed according to foreign population standards are applied to the domestic population. Nevertheless, knowledge of the normal values of the anatomical parameters of the knee joint and sex, age, and side differences in them can provide a reference for the design of replacement prostheses.  
OBJECTIVE: To explore the normal anatomical parameters of bilateral normal knee joints and the age and sex differences in Guiyang.
METHODS: We conducted a retrospective observational cohort study of 2 978 patients with normal knee joints in Guiyang from 13 666 patients who underwent knee X-ray examination in Guizhou Provincial People’s Hospital from January 2015 to January 2021. Anatomical parameters, including the line parameters (knee space width, femoral condyle diameter, tibial plateau diameter, and Insall-Salvati index), and the angle parameters (femoral angle, femoral tibial angle, tibial angle, and posterior tibial slope) were measured on anteroposterior and lateral radiographs of the knee joint. Age, sex and side differences were compared.  
RESULTS AND CONCLUSION: (1) Sex differences in the femoral angle, femoral tibial angle, tibial angle, knee joint space, transverse diameter of femoral condyle, transverse diameter of tibial plateau, and Insall-Salvati index were found (P < 0.05). The femoral angle and Insall-Salvati index were higher in women than in men, while other parameters were lower in women than in men. There was no significant difference in posterior tibial slope (t=-0.64, P=0.523). (2) There were significant age differences in femoral tibial angle, lateral knee joint space in men and femoral tibial angle, tibial angle tibial plateau diameter in women (P < 0.05). (3) The femoral tibial angle in men and women aged 36-45 years and the tibial angle in women was the largest. The lateral knee joint gap of man aged 27-35 years (7.78±0.72) mm was larger than that in other groups. The transverse diameter of tibial plateau in women aged 18-26 years (72.08±5.81) mm was greater than that in other groups. There was no significant difference in other parameters (P > 0.05). (4) There were significant differences in the femoral angle, femoral tibial angle, tibial angle, posterior tibial slope, knee space, femoral condyle diameter, and Insall-Salvati index between bilateral knees (P < 0.05). Parameters were increased at the right side compared with the left side with the exception of femoral angle. There was no significant difference in the transverse diameter of tibial angle and tibial plateau (P > 0.05). (5) The results confirm that sex and side differences in the anatomical parameters of normal knee joints exist in subjects from Guiyang; however, the age differences are hardly detected. This study can provide normal knee values for prosthesis design in Guiyang.

Key words: normal population, knee joint, knee osteoarthritis, anatomical parameter, X-ray, normal value

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