Cortical and medullary morphology of the tibia.
Cortical and medullary morphology of the tibia.
复制标题
胫骨的皮质和髓质形态。
DOI：
10.1002/ar.24479
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Bachus KN
中科院分区：
文献类型：
--
作者：
Taylor CE;Henninger HB;Bachus KN
对于利用骨整合(OI)进行骨骼固定的骨科内假体来说，由于应力遮挡和骨-种植体接触不足而引起的骨吸收仍然是个问题。形态分析通过定义解剖学参数，通过最大化骨与种植体的接触来优化假体负荷，从而帮助解决这一问题。这些研究通常不包括骨干髓质形态，因为这一区域与全关节置换术无关。相反，用于假肢附着物的经皮OI内假体放置在长骨的骨干内。本研究利用计算机断层扫描(CT)对116例新鲜冷冻的人身体胫骨的皮质和髓质形态进行了研究。选择解剖标志，并使用定制的MatLab脚本分析归一化到生物力学长度(BML)的皮质和髓质横断面形态。BML测量胫骨平台至胫骨平台的距离。测量皮质层厚度、髓管直径和髓管圆形等指标。我们测试了性别和偏侧性对形态的影响，并检查了沿骨骼长度的变化。结果表明，虽然性别和偏侧性都影响解剖标志的位置，但只有性别影响横断面形态。总体而言，形态显著影响骨长度方向的形状，所有被检查的属性，除了髓圆外。分析发现，35%BML以下的根管有利于圆形种植，髓腔直径在13~32 mm之间，20%~80%BML之间。一个大的尺寸范围是必要的，以充分的种植体接触，以适应截肢后的残肢长度。
Bone resorption caused by stress shielding and insufficient bone-implant contact continues to be problematic for orthopaedic endoprostheses that utilize osseointegration (OI) for skeletal fixation. Morphologic analyses have helped combat this issue by defining anatomic parameters to optimize endoprosthesis loading by maximizing bone-implant contact. These studies have not typically included diaphyseal medullary morphology, as this region is not pertinent to total joint replacement. To the contrary, percutaneous OI endoprostheses for prosthetic limb attachment are placed in the diaphysis of the long bone. This study examined the cortical and medullary morphology of 116 fresh-frozen human cadaveric tibia using computed tomography (CT). Anatomic landmarks were selected and custom Matlab scripts were used to analyze the cross-sectional cortical and medullary morphology normalized to biomechanical length (BML). BML measured the distance between the tibial plateau and the tibial plafond. Properties such as cortical thickness, medullary diameter, and circularity of the medullary canal were quantified. We tested the influence of sex and laterality on morphology, and examined variations along the length of the bone. Results showed that while both sex and laterality impacted the location of anatomic landmarks, only sex influenced cross-sectional morphology. Overall, morphology significantly affected shape along the length of the bone for all examined properties except medullary circularity. This analysis found that distal to 35% BML, the canal is conducive to a circular implant, with medullary diameter ranging from 13–32 mm between 20–80% BML. A large size range is necessary for sufficient implant contact in order to accommodate residual limb length after amputation.
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