国人正常肱骨近段CT测量与假体设计的相关研究
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摘要
目的：测量国人肱骨近段的相关解剖数据，为设计适合中国人的肱骨头假体提供参考值。方法：50根成对防腐肱骨(男14对，女11对)按肱骨头扭转角置于冠状位和矢状位，行肱骨全长，头颈矢状面，解剖颈下缘及其下20mm、40mm，髓腔狭窄部四平面CT扫描，由CT软件测量冠、矢状位髓腔内外参数共61项，包括头心—干轴距，头位置，头干角，头—结节高度差，头厚度，头半径，关节面张角，解剖颈直径，髓腔狭窄部位置，解剖颈下缘及其下20mm、40mm和狭窄部四个平面髓腔的最大冠、矢状径，皮质骨厚度等。并在此基础上得出张口指数，张口变化和皮髓指数。结果：所得数据行统计学处理，得出各参数均值、标准差、最大值、最小值和部分参数的分布规律及其间的相关性，包括性别、左右分组参数的均值和标准差。同时行t检验比较组间差异显示：性别间大多参数差异显著，而左右间大多参数差异不显著。并与西方人相应参数对比，差异有非常显著性意义(P<0.01)。结论：有必要设计符合国人肱骨解剖特点的假体，假体尺寸规格应多样化，并且在设计和选择假体时需考虑性别差异。
Objective：Measurement of Chinese proximal humeri for the design of humeral prosthesis component by CT osteometry. Methods：Fifty paired embalmed cadaveric humeri (twenty-five pairs:fourteen from male donors and eleven from female donors) were scanned in medial-lateral(ML) and anterior-posterior(AP) position according to the humeral retroversion by CT. Images of the humeri in the transverse planes at the lowest border of neck(LBN),20mm and 40mm distal of LBN(LBN-20、LBN-40), isthmus, head-neck anterior-posterior(HN-AP)were obtained. Sixty-one extracortical and intracortical parameters were measured exactly by image analytic computer software that included offset, head position, head-shaft angle, head to tuberosity height (HT), head thickness, curvature radius, articular surface arc (SA), neck diameter, isthmus position, proximal and distal border of isthmus, maximum coronal and sagittal diameter of medullary canal and thickness of cortical bone in four planes, including LBN, LBN-20,LBN-40 and isthmus. Additionally, flare index (FI), flare variation (FV) and cortico-medullary index (CMI) were also gained. All the measurements were
underwent statistical analysis by SAS system .Results: Based upon the results of this analysis ,the means ,standard deviation, minimum and maximum of all parameters were obtained.The principles of the frequency distribution, correlation and confidence in part parameters were also found.The means and standard deviation of all parameters in male and female, right and left were acquired .In addition,profound differences were observed between male and female,the Chinese and the Caucasian .However, there were no significance difference between right and left.Conclusion:The author consider that it is mandatory to design the humeral components fitting the feature of the humeri of the Chinese and diversifying the size, consider the difference of gender on designing and selecting of prostheses.
Objective：Measurement of Chinese proximal humeri for the design of humeral prosthesis component by CT osteometry. Methods：Fifty paired embalmed cadaveric humeri (twenty-five pairs:fourteen from male donors and eleven from female donors) were scanned in medial-lateral(ML) and anterior-posterior(AP) position according to the humeral retroversion by CT. Images of the humeri in the transverse planes at the lowest border of neck(LBN),20mm and 40mm distal of LBN(LBN-20、LBN-40), isthmus, head-neck anterior-posterior(HN-AP)were obtained. Sixty-one extracortical and intracortical parameters were measured exactly by image analytic computer software that included offset, head position, head-shaft angle, head to tuberosity height (HT), head thickness, curvature radius, articular surface arc (SA), neck diameter, isthmus position, proximal and distal border of isthmus, maximum coronal and sagittal diameter of medullary canal and thickness of cortical bone in four planes, including LBN, LBN-20,LBN-40 and isthmus. Additionally, flare index (FI), flare variation (FV) and cortico-medullary index (CMI) were also gained. All the measurements were
underwent statistical analysis by SAS system .Results: Based upon the results of this analysis ,the means ,standard deviation, minimum and maximum of all parameters were obtained.The principles of the frequency distribution, correlation and confidence in part parameters were also found.The means and standard deviation of all parameters in male and female, right and left were acquired .In addition,profound differences were observed between male and female,the Chinese and the Caucasian .However, there were no significance difference between right and left.Conclusion:The author consider that it is mandatory to design the humeral components fitting the feature of the humeri of the Chinese and diversifying the size, consider the difference of gender on designing and selecting of prostheses.
引文
1. Joseph PI , Josue PG, Stephanie LS,et al.The normal glenohumeral relationships.J Bone Joint Surg,1992,74-A:491-500.
2．Harryman DT, Sidles JA, Clark JM, et al.Translation of the humeral head on the glenoid with passive glenohumeral motion.J Bone Joint Surg,1990,72-A:1334-1343.
3．Harryman DT,Sidles JA,Harris SI ,et al.The effect of articular conformity and the size of the humeral head component on laxity and motion after glenohumeral arthroplasty:a study in cadavera.J Bone Joint Surg, 1995,77-A:555-563.
4．Michael LP, Sam K, Los AC. Geometric analysis of commonly used prosthetic systems for proximal humeral replacement .J Bone Joint Surg, 1999,81-A:660-671.
5．Ballmer FT, Sidles JA, Lippitt SB, et al. Humeral prosthetic arthroplasty: surgically relevant considerations.J Shoulder Elbow Surg,1993,2:296-304.
6．Oskar DL, Piet MR,Leonard AR, et al.Influence of glenohumeral prosthesis geometry and placement on shoulder muscle forces. Clin Orthop,1996,330:222-223.
7. Neer CS,Watson KC,Stanton FJ.Recent experience in total shoulder replacement.J Bone Joint Surg,1982,64-A:319-337.
8．Figgie HE, Inglis AE,Goldberg VM,et al.An analysis of factors affecting the long term results of total shoulder arthroplasty in inflammatory arthritis.J Arthroplasty,1988,3:123-130.
9．Rietveld ABM,Daanen HAM,Rezing PM,et al.The lever arm in glenohumeral abduction after hemiarthroplasty.J Bone Joint Surg,1988,70-B：561-565.
10．卢世壁，戴尅戎，张育才，等. 人工关节的基础与临床研究.
第1版. 北京：人民卫生出版社，1993: 25-27.
11．吕厚山. 人工关节外科学. 第1版. 北京：科学出版社，1998:6-7.
12．郭世绂. 骨科临床解剖学. 第1版. 天津：天津科学技术出版社，1988:434-435.
13． 王震宇，戴尅戎. 股骨距与股骨上段有效髓腔的几何形态学研究. 中华骨科杂志，1994,14:436-440.
14．李应义，杨玉田. 国人肱骨扭转角的测量.解剖学通报，1982，
5(增):121.
15．汪臻. CT技术及其临床应用. 北京：中国医药科技出版社，1988:36.
16．卢光明，陈君坤. CT诊断与鉴别诊断. 第1版. 南京:东南大学出版社，1999:2.
17．章纯光，吕厚山，邹德威. 国人正常股骨CT测量与假体设计的相关研究. 中华骨科杂志，1998,18:467-470.
18．Bioleau P,Walch G.The three-dimensional geometry of the proximal humer us.J Bone Joint Surg,1997,79-B:857-865.
19. Evan L, Flatow.Prosthetic design considerations in total shoulder arthroplasty.Semin Arthroplasty,1995,6:233-244.
20．杨娃姣，高雨仁，王玉海，等. 肱骨胫骨骨髓腔的应用解剖. 解剖学杂志，1992,15:3-5.
21．王永清，罗先正，刘长贵，等. 国人股骨胫骨髓腔的形态学研究及带锁髓内钉的改进. 中华骨科杂志，1998,18:215-218.
22．韩一生，赵广跃，刘建，等. 非扩髓型肱骨内锁髓内钉的研制和临床应用. 中华骨科杂志，1997,17:229-232.
23．陈昌富，李传夫，张锋. 肱骨头两维平面激光投影测量. 解剖学报，1988,19:338-341.
24. Rubin PJ, Legvraz PF, Anbaniac JM. The morphology of the proximal femur, A three-dimensional radiographic analysis .J Bone Joint Surg,1992,74-B:28-32.
25．王鸣鹏. 实用CT检查技术学. 第1版. 北京：科学技术文献出版社，1999:3-4.
26．Pearl ML,Volk AG:Coronal plane geometry of the proximal humerus relevant to prosthetic arthroplasty.J Shoulder Elbow Surg ,1996,5:320-326.
27．Simon NJ , Andrew PJ, Heather MS ,et al .The geometry of the humeral head and the design of prosthesis. J Bone Joint Surg ,1991,73-B:647-650.
28．Douglas DR,Jie Y,Louis UB,et al.Three dimensional analysis of the
proximal part of the humerus：relevance to arthroplasty. J Bone Joint Surg,2000,82-A:1594-1602.
29．范冷艳. 肱骨滋养孔及滋养动脉. 解剖学报，1982,13:19.
30．Friedman RJ. Biomechanics of the shoulder following total shoulder replacement.In:Post M,Morrey BF,Hawkins RJ,eds.Surgery of the shoulder.St Loueis, Mosby-Year Book.1990:263-266.
31．Bioleau P, Walch G,Liotard JP.Cineradiographic study of active elevation of the prosthetic shoulder.J Orthop Surg ,1992,6:351-359.
32．Jobe CM,Iannotti JP.Limits imposed on glenohumeral motion by joint geometry.J Shoulder Elbow Surg,1995,4:281-285.
33．Bioleau P,Walch G.Varus shoulder prosthesis:eror or necessity?J Shoulder Elbow Surg, 1996,S62:186.
34．Fischer LP,Carret JP,Gonon GP,et al.Etude cinematique des mouvements de l`articulation scapulo-humerale (Articulatio Humeri).Rev Chir Orthop 1977,63(suppl Ⅱ):108-112.
35．Fenlin JM,Vacaro A,Andreichik D,et al.Modular total shoulder:early experience and impressions Seminars in Arthroplasty,1990,1:2:102-111.
36．Soslowski LJ, Flatow LE,Bigliani LU,et al.Articular geometry of the glenohumeral joint.Clin Orthop ,1992,285:181-190.
37．Howell SM,Galinat BJ.The glenoid-labral socket:A constrained articular surface.Clin Orthop,1988,243:122-125.
38．Van der Helm FCT,Pronk GM,Veeger HEJ,et al.The rotation center of the glenohumeral joint.In Whiting WC(ed).Proceedings of the Twelfth International Society of Biomechanics Congress, Los Angeles,1989:
676-677.
39．Harryman DT,Sidles JA,Matsen FA,et al.The humeral head translates on the the glenoid with passive motion .In Surgery of the Shoulder, pp:186-190.Edited by Hawkins RJ, Morrey BF,Post M.st. Louis, Mosby-Year Book,1990.
40．Howell SM, Galiant BJ, Renzi AJ,et al. Normal and abnormal mechanics of the glenuhomeral joint in the horizontal plane.J Bome Joint Surg,1988,70-A:227-2323．
41．Poppen NK,Walker PS.Normal and abnormal motion of the shouder .J Bone Joint Surg,1976,58-A:195-201.
42．Neer CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg,1974,56-A:1-13.
43. Neer CS. Glenohumeral arthroplasty.In Shoulder Reconstruction,pp:147-187.Philadelphia, W.B. Saunders,1990.
44．Franklin JL,Barrett WP, Jackins SE,et al.Glenoid loosening in total shoulder arthroplasty.Association with rotator cuff deficiency.J Arthroplasty,1988,3:39-45．Collins DN,Harryman DT,Lippitt SB,et al.The technique of glenohumeral arthroplasty. Techniques Orthop,1991,6:43-59.
46．Noble PC, Box GG, Kamaric E, et al .The effect of aging on the shape of the proximal femur.Clin Orthop,1995,316;31-44.
47. Walch G, Bioleau P. Morphological study of the humeral proximal epiphysis .J Bone Joint Surg, 1992,74-B:Suppl I:14.
48．Bioleau P,Walch G. The combined offset (medial and posterior) of the humeral sphere .J Shoulder Elbow Surg,1994,3:6.
49．Bioleau P,Walch G. Adaptabilite et modularite au cours des prostheses d'epaule.Acta Orthop Belg,1995,61:Suppl I:49-61.
2．Harryman DT, Sidles JA, Clark JM, et al.Translation of the humeral head on the glenoid with passive glenohumeral motion.J Bone Joint Surg,1990,72-A:1334-1343.
3．Harryman DT,Sidles JA,Harris SI ,et al.The effect of articular conformity and the size of the humeral head component on laxity and motion after glenohumeral arthroplasty:a study in cadavera.J Bone Joint Surg, 1995,77-A:555-563.
4．Michael LP, Sam K, Los AC. Geometric analysis of commonly used prosthetic systems for proximal humeral replacement .J Bone Joint Surg, 1999,81-A:660-671.
5．Ballmer FT, Sidles JA, Lippitt SB, et al. Humeral prosthetic arthroplasty: surgically relevant considerations.J Shoulder Elbow Surg,1993,2:296-304.
6．Oskar DL, Piet MR,Leonard AR, et al.Influence of glenohumeral prosthesis geometry and placement on shoulder muscle forces. Clin Orthop,1996,330:222-223.
7. Neer CS,Watson KC,Stanton FJ.Recent experience in total shoulder replacement.J Bone Joint Surg,1982,64-A:319-337.
8．Figgie HE, Inglis AE,Goldberg VM,et al.An analysis of factors affecting the long term results of total shoulder arthroplasty in inflammatory arthritis.J Arthroplasty,1988,3:123-130.
9．Rietveld ABM,Daanen HAM,Rezing PM,et al.The lever arm in glenohumeral abduction after hemiarthroplasty.J Bone Joint Surg,1988,70-B：561-565.
10．卢世壁，戴尅戎，张育才，等. 人工关节的基础与临床研究.
第1版. 北京：人民卫生出版社，1993: 25-27.
11．吕厚山. 人工关节外科学. 第1版. 北京：科学出版社，1998:6-7.
12．郭世绂. 骨科临床解剖学. 第1版. 天津：天津科学技术出版社，1988:434-435.
13． 王震宇，戴尅戎. 股骨距与股骨上段有效髓腔的几何形态学研究. 中华骨科杂志，1994,14:436-440.
14．李应义，杨玉田. 国人肱骨扭转角的测量.解剖学通报，1982，
5(增):121.
15．汪臻. CT技术及其临床应用. 北京：中国医药科技出版社，1988:36.
16．卢光明，陈君坤. CT诊断与鉴别诊断. 第1版. 南京:东南大学出版社，1999:2.
17．章纯光，吕厚山，邹德威. 国人正常股骨CT测量与假体设计的相关研究. 中华骨科杂志，1998,18:467-470.
18．Bioleau P,Walch G.The three-dimensional geometry of the proximal humer us.J Bone Joint Surg,1997,79-B:857-865.
19. Evan L, Flatow.Prosthetic design considerations in total shoulder arthroplasty.Semin Arthroplasty,1995,6:233-244.
20．杨娃姣，高雨仁，王玉海，等. 肱骨胫骨骨髓腔的应用解剖. 解剖学杂志，1992,15:3-5.
21．王永清，罗先正，刘长贵，等. 国人股骨胫骨髓腔的形态学研究及带锁髓内钉的改进. 中华骨科杂志，1998,18:215-218.
22．韩一生，赵广跃，刘建，等. 非扩髓型肱骨内锁髓内钉的研制和临床应用. 中华骨科杂志，1997,17:229-232.
23．陈昌富，李传夫，张锋. 肱骨头两维平面激光投影测量. 解剖学报，1988,19:338-341.
24. Rubin PJ, Legvraz PF, Anbaniac JM. The morphology of the proximal femur, A three-dimensional radiographic analysis .J Bone Joint Surg,1992,74-B:28-32.
25．王鸣鹏. 实用CT检查技术学. 第1版. 北京：科学技术文献出版社，1999:3-4.
26．Pearl ML,Volk AG:Coronal plane geometry of the proximal humerus relevant to prosthetic arthroplasty.J Shoulder Elbow Surg ,1996,5:320-326.
27．Simon NJ , Andrew PJ, Heather MS ,et al .The geometry of the humeral head and the design of prosthesis. J Bone Joint Surg ,1991,73-B:647-650.
28．Douglas DR,Jie Y,Louis UB,et al.Three dimensional analysis of the
proximal part of the humerus：relevance to arthroplasty. J Bone Joint Surg,2000,82-A:1594-1602.
29．范冷艳. 肱骨滋养孔及滋养动脉. 解剖学报，1982,13:19.
30．Friedman RJ. Biomechanics of the shoulder following total shoulder replacement.In:Post M,Morrey BF,Hawkins RJ,eds.Surgery of the shoulder.St Loueis, Mosby-Year Book.1990:263-266.
31．Bioleau P, Walch G,Liotard JP.Cineradiographic study of active elevation of the prosthetic shoulder.J Orthop Surg ,1992,6:351-359.
32．Jobe CM,Iannotti JP.Limits imposed on glenohumeral motion by joint geometry.J Shoulder Elbow Surg,1995,4:281-285.
33．Bioleau P,Walch G.Varus shoulder prosthesis:eror or necessity?J Shoulder Elbow Surg, 1996,S62:186.
34．Fischer LP,Carret JP,Gonon GP,et al.Etude cinematique des mouvements de l`articulation scapulo-humerale (Articulatio Humeri).Rev Chir Orthop 1977,63(suppl Ⅱ):108-112.
35．Fenlin JM,Vacaro A,Andreichik D,et al.Modular total shoulder:early experience and impressions Seminars in Arthroplasty,1990,1:2:102-111.
36．Soslowski LJ, Flatow LE,Bigliani LU,et al.Articular geometry of the glenohumeral joint.Clin Orthop ,1992,285:181-190.
37．Howell SM,Galinat BJ.The glenoid-labral socket:A constrained articular surface.Clin Orthop,1988,243:122-125.
38．Van der Helm FCT,Pronk GM,Veeger HEJ,et al.The rotation center of the glenohumeral joint.In Whiting WC(ed).Proceedings of the Twelfth International Society of Biomechanics Congress, Los Angeles,1989:
676-677.
39．Harryman DT,Sidles JA,Matsen FA,et al.The humeral head translates on the the glenoid with passive motion .In Surgery of the Shoulder, pp:186-190.Edited by Hawkins RJ, Morrey BF,Post M.st. Louis, Mosby-Year Book,1990.
40．Howell SM, Galiant BJ, Renzi AJ,et al. Normal and abnormal mechanics of the glenuhomeral joint in the horizontal plane.J Bome Joint Surg,1988,70-A:227-2323．
41．Poppen NK,Walker PS.Normal and abnormal motion of the shouder .J Bone Joint Surg,1976,58-A:195-201.
42．Neer CS. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg,1974,56-A:1-13.
43. Neer CS. Glenohumeral arthroplasty.In Shoulder Reconstruction,pp:147-187.Philadelphia, W.B. Saunders,1990.
44．Franklin JL,Barrett WP, Jackins SE,et al.Glenoid loosening in total shoulder arthroplasty.Association with rotator cuff deficiency.J Arthroplasty,1988,3:39-45．Collins DN,Harryman DT,Lippitt SB,et al.The technique of glenohumeral arthroplasty. Techniques Orthop,1991,6:43-59.
46．Noble PC, Box GG, Kamaric E, et al .The effect of aging on the shape of the proximal femur.Clin Orthop,1995,316;31-44.
47. Walch G, Bioleau P. Morphological study of the humeral proximal epiphysis .J Bone Joint Surg, 1992,74-B:Suppl I:14.
48．Bioleau P,Walch G. The combined offset (medial and posterior) of the humeral sphere .J Shoulder Elbow Surg,1994,3:6.
49．Bioleau P,Walch G. Adaptabilite et modularite au cours des prostheses d'epaule.Acta Orthop Belg,1995,61:Suppl I:49-61.
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