A Preliminary Study On Ankle Morphology Parameters Of Southwest Chinese

Background:The common damage and disease of ankle often causes terminal stage ankle arthritis.The general accepted golden standard for treatment of terminal stage ankle arthritis is ankle fusion.Though it can alleviate pain,rectify ankle malformation and improve ankle stability,the ankle function compensated by attached join after fusing may cause retrogressive change of joint and re-cause pain for a long term.In addition,there are problems of joint stiffness,nonunion and malunion problems for fused ankle.The TAR is a new surgical method which has began to use on the clinical treatment of terminal stage ankle arthritis in 1970 s.Through more than 40 years development,the TAR has been accepted by clinical orthopedist and used widely both at home and abroad.The research shows the the TAR has better effect and is more closed to the physiological statue than ankle fusion for patient who satisfies the requirement of TAR.With the improvements of prosthesis design and making,the TAR will significantly improve the life quality of patient.Our office has began use TAR since 2003 with satisfied effect.However,after more than 10 years clinical application,we has found that the size of ankle prosthesis may not confirm to Chinese that the oversize prosthesis may increase bone resection and cause internal or external ankle fracture or increase the separation work for surrounding soft tissues and influence the wound healing,while the undersize prosthesis cannot perfectly fall on the osteotomy surface cortex of tibia or talus and cause prosthesis subsidence,displacement,loose,or even dislocation.We think this may have connection to the application of ankle prosthesis that currently the used ankle prosthesis in China is imported from foreign countries--the size and specification of prosthesis are designed according to the morphological parameter of foreign people.However,the osteological features of Asian people and foreign people have difference that the size of imported foreign ankle prosthesis may not confirm to Chinese.As a result,it is important to research the ankle morphological parameter of Chinese and design new ankle prosthesis for Chinese are necessary for improving the math ratio of ankle prosthesis and decreasing complication.Objective:1.Measuring and analyzing the morphological parameter for X plain film of normal adult’s ankle of southwest China area so as to provide reference for designing new domestic ankle prosthesis.2.Measuring and analyzing the morphological parameter for CT film of normal adult’s ankle of southwest China area so as to provide reference for designing new domestic ankle prosthesis.Method:1.Collecting image data of normal ankle of X-ray from May 2014 to August 2015 of our hospital.Inclusion criteria: 1.Age range 18years-75 years old;2.southwest Chinese;3.Finding no ankle malformation through physical examination;4.The X-ray image of ankle under no pressure.Exclusion criteria: 1.Fuzziness or undesirable image;2.The imaged ankle has surgery history;3.The X-ray image of ankle which possesses infection,tumor,malformation or other factors that may influence the normal morphology of ankle.This research includes 100 X-ray images according to the inclusion criteria and exclusion criteria,among which there are 67 Chongqing people,26 Sichuan people,27 Guizhou people;50 males,50 females;and 50 left ankles,50 right ankles.The people are ranged from 18-75 years old in age(38.40 years old ± 12.41 years old),47-85 kg in weight(59.63±8.28kg),and154~185cmin height(165.35±7.45cm).Then the research employs PACS image and word analysis system to measure APG,Ti W and other in total 13 parameters of each ankle X-ray image.2.Collecting image data of normal ankle of 64 rank CT from January 2015 to March 2016 of our hospital.Inclusion criteria: 1.Age range 19-63 years old;2.southwest Chinese;3.Finding no ankle malformation through physical examination;4.The CT image of ankle under no pressure.Exclusion criteria: 1.Fuzziness or undesirable image;2.The imaged ankle has surgery history;3.The CT image of ankle which possesses infection,tumor,malformation or other factors that may influence the normal morphology of ankle.This research includes 26 CT images according to the inclusion criteria and exclusion criteria,among which there are 19 Chongqing people,5 Sichuan people,2 Guizhou people;13 males,13 females;and 13 left ankles,13 right ankles.The people are ranged from 19-63 years old in age(37.03 years old ± 11.94 years old),45-80 kg in weight(60.69kg±8.79kg),and 152-180 cm in height(164.46cm±7.21cm).Then the research employs PACS image and word analysis system to measure FTiw,MTiw and other in total 16 parameters of each ankle CT image.Result:1.(1)Southwest Chinese normal adults ankle morphological parameters compared with the Italians,besides tibial width(Ti W),distance of level of MTi Th from the anterior limit of the mortise(MDA),distance of level of MTiTh from the vertex of the mortise(MDV),and the aspect ratio of talus(Ta AL/Ta W),thattrochlea tali length(Ta AL),tarsal width(Ta W),etc,nine ankle morphology parameters,exist obvious statistical difference(p < 0.01);Compared with the Koreans,Tibial arc length(Ti AL),the tibial width(Ti W),etc,6 ankle morphology parameters present no statistical difference.While the trochlea tali length(Ta AL),the tarsal width(Ta W),etc,7 ankle morphology parameters present statistical difference.(2)The Trochlea tali length(TaAL),Compared to men and women in southwest China,besides the tibial aspect ratio(MTi Th/Ti W),the aspect ratio of talus(TaAL/TaW),the width of the ankle and tibial width ratio(MalW/Ti W),that tibial axc length(TiAL),tibial width(Ti W),tarsal width(Ta W),etc,10 ankle morphology parameters present statistical differences(P < 0.05).2.(1)The research,through comparing the CT morphological parameters of normal adult’s ankle of southwest China area with Italian,finds that except for Ti W,Ta W and other in toal 3 ankle morphological parameters,the Ta Al,Ta W and other in total 7 ankle morphological parameters have statistical difference(P<0.05),among which: hte APA and Mal W have significant statistical different(P<0.05);the APA and APG of Chinese are bigger than Italian while Ti AL,Ta AL and other in total 5 parameters of Chinese are smaller than Italian.Meanwhile,through comparing the CT morphological parameters of normal adult’s ankle of southwest China area with Korean,finds that except for Ta Al,Ta W and other in total 4 ankle morphological parameters have statistical difference,Ti AL,Ti W and other in taltal 6 ankle morphological parameters have no statistical difference.Above results are relatively similar to the morphological parameters results acquired by employing ankle X plain film for measurement.(2)The Trochlea tali length(TaAL),Compared to men and women in southwest China,besides MDV,APA,Ta AL,that tibial axc length(Ti AL),tibial width(Ti W),tarsal width(Ta W),etc,13 ankle morphology parameters present statistical differences(P < 0.05).(3)The talus surface of southwest Chinese decrease from front to back in linear trend that is similar to the decrease rules of Taiwan people measured by Chien-chung Kuo[22] etc and American measured by Hayes[21] etc.Meanwhile,the decrease degrees of talus Antero-width and talus middle-width of southwest Chinese are similar to the decrease degree of talus width of American reported by Hayes[23]etc,while the decrease degrees of talus middle-width and talus rear-width are obviously bigger than American.The decrease degrees of talus Antero-width and talus middle-width of southwest Chinese are smaller than Taiwan people measured by Chien-chung Kuo[22] etc,while the decrease degrees of talus middle-width and talus rear-width are similar to the Taiwan people measured by Chien-chung Kuo[22] etc.Conclusion:1.(1)Southwest Chinese normal adults ankle configuration parameters compare with Italy and South Korea,there exist difference,and the difference towards Italian is bigger,but close to the Korean people.(2)The southwest Chinese exist differences between men and women,and men parameter values are greater than women.2.(1)The CT morphological parameter of normal adult’s ankle of southwest China area has difference with Korean,has significant difference with Italian,and is similar to Korean that the result are relatively similar to the morphological parameters results acquired by employing ankle X plain film for measurement.(2)The southwest Chinese exist differences between men and women,and men parameter values are greater than women.(3)The talus surface of southwest Chinese decrease from front to back that is similar to the decrease rules of Taiwan people and American.The decrease trend of talus surface of southwest Chinese decrease from front to back has difference with American and Taiwan people so that the talus surface morphology of southwest Chinese’s ankle has difference with American and Taiwan people.Moreover,the southwest Chinese has lower decrease degree for the ankle mortise from front to back,and the ankle mortise is like a square.