摘要
目的：探索全膝关节置换术中对称型与非对称型胫骨假体对胫骨断面及胫骨端面前内象限覆盖率的差别。
材料与方法：本实验选用胫骨平台标本30个，其中20个来自我科全膝关节置换术中切取的标本，10个尸体干标本。选用3种类型的胫骨假体进行比较，其中Genesis Ⅱ型胫骨假体为非对称型，I-BⅡ、PFC胫骨假体为对称型。
胫骨截骨选用髓外定位系统。截骨厚度6-10mm。胫骨断面后倾6度。为每个胫骨断面从三种胫骨假体中分别选择一个能最大覆盖断面的假体。保持相同的放大率，摄取胫骨断面及与之相对应的胫骨假体的数码相片。将数码相片输入计算机，计算出胫骨假体占胫骨断面的百分比。用透明硬质塑料板将胫骨断面及与之相对应的胫骨假体制成模板，分别从胫骨断面模板和假体模板上用黑笔画出前内象限，再摄取数码相片，将相片输入计算机，计算出假体前内象限的百分比。用配对t检验的方法，检验非对称型假体和对称型假体对胫骨断面及断面前内侧覆盖率的差异性。
结果：通过计算机分析Genesis Ⅱ假体对胫骨断面的覆盖率是88.41±1.94％；PFC假体对胫骨断面的覆盖率是83.21±3.28％；I-BⅡ假体对胫骨断面的覆盖率是79.81±3.86％。通过配对t检验，
天津医科大学硕士论文
Genesis 11假体对胫骨断面的覆盖率与PFC相比，p<0.001，Genesis
11与I一Bll相比，p<0.05。
GenesiSH假体对胫骨断面前内象限的覆盖率是82.09士n.42%;
PFC假体对胫骨断面前内象限的覆盖率是50.81士8.23ry0;I一BH假
体对胫骨断面前内象限的覆盖率是75.04士13.66%。通过配对t
检验，GenesiS 11假体对胫骨断面前内象限的覆盖率与PFC相比，
p<0.05，Genesis 11与I一B 11相比，p<0.001。
结论:非对称型胫骨假体对胫骨近端截骨面的覆盖率明显高
于对称型胫骨假体。非对称型胫骨假体对胫骨近端截骨面前内象
限的覆盖率明显高于对称型胫骨假体。
Objective:To explore the difference of coverage rate at which the resected proximal tibia and anteomedial quadrant of it are covered by a symmetric prothesis and a asymmetric one in the course of total knee arthroplasty.
Matherials and methods :We select 30 tibial plateau specimens in the trial,of them,20 specimens are the resected tibial plateau ones from total knee arthroplasties in our operating room, 10 specimens are dry cadaver tibial plateau ones.Three kinds of tibial prothesis are compared .Of them ,Genesis II tibial prothesis is asymmetric ,I-B II ,PFC tibial prothesis are symmetric.
The tibial plateau is resected by extramedullary guide,all the resection specimens have a measured thickness of 6-10mm,the resection surface posteriorly slope by 6?.For each tibial specimen,we select one tibial prothesis respectively that can covered tibial plateau by the highest rate from three kinds of prothesis.The tibial specimen and the related prothesis are photographed digitally by the same gratifying rate.The digital photoes are sent to computer,the rate at which the tibial specimen is covered by the tibial prothesis is
calculated.Exact templates of tibial section and tray basplates are produced with transparency plastic sheet. The anteomedial quadrants are landmarked with black pencil on the templates of resections and tray basplates, the digital photoes are taken .The digital photoes are sent to computer,the coverage rate at which the anteomedial quadrant of the tibial section is covered by the anteomedial quadrant of the tibial tray.With the paired-t test method, test the difference of coverage rate at which the resected proximal tibia and anteomedial quadrant of it are covered by a symmetric prothesis and a asymmetric one in the course of total knee arthroplasty.
Resultrby the analysis of computer ,the average coverage rate of Genesis II tray to the resected specimens is 88.41 + 1.94%; that of PFC tray is 83.21+ 3.28%;that of I-B IItray is 79.81?.86% .By paired -t test ,the coverage rate of Genesis II tray to the resected specimens is compared to that of PFC tray(P<0.001).The coverage rate of Genesis II tray to that of I-B IItray(P<0.05).The coverage rate of Genesis II tray to the anteomedial quadrant of resected specimens is 82.09+11.42%, that of PFC tray to the anteomedial quadrant of resected specimens is 80.81 + 8.23%, that of I-B II tray to anteomedial quadrant of resected specimens is 75.04?3.66%. By
paired -t test ,the coverage rate of Genesis II tray to the anteomedial quadrant resected specimens is compared to that of PFC tray(P<0.001).The coverage rate of Genesis II tray to that of I-B II tray(P<0.05).
Conclusion: the coverage rate at which the resected proximal tibia and anteomedial quadrant of it are covered by a asymmetric prothesis is much higher than that of a symmetric prothesis.
引文
1．吕厚山主编 人工关节外科学 科学出版社
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