肱骨远端关节软骨的三维分布及双侧配准研究

doi:10.3877/cma.j.issn.2095-5790.2023.04.006

目的

评估肱骨远端关节面软骨的三维分布情况并比较双侧肘关节软骨分布的差异性，同时对影响肘关节软骨个体差异的危险因素进行初步分析。

方法

收集2021年1月至2022年12月就诊本院行双侧肘关节3D-MRI、无骨性、软骨结构异常患者，36例受试者包括女17例、男19例；年龄23~45岁，平均34.8岁，右利手26例。没有骨关节炎受试者纳入。收集纳入受试者特征以及影像学数据，影像学数据以DICOM格式传输到MIMICS 21.0软件中，建立相应三维坐标系，以矢状面图像上垂直于软骨下骨方向为标准，在多个位置进行软骨厚度测量。评估正常中青年肱骨远端关节面软骨厚度分布情况、双侧关节软骨厚度一致性及应力关节面软骨厚度的影响因素分析。

结果

主力侧肱骨远端软骨位于肱骨滑车外侧缘7点钟位置最厚（1.54±0.39）mm，肱骨小头外侧缘2点钟位置最薄（0.09±0.31）mm；非主力侧软骨位于肱骨小头外侧缘6点钟位置最厚（1.49±0.29）mm，肱骨滑车内侧缘11点位置最薄（0.03±0.16）mm。关节软骨分布最厚较最薄点差异具有统计学意义（主力侧P<0.01,非主力侧P<0.01）。在双侧软骨分布的比较中，双侧关节面软骨厚度差异最大为（0.17±0.38）mm，差异无统计学意义。经过Wilks典型相关性分析关节面域软骨厚度与年龄、性别、主力侧和劳动类型均差异无统计学意义（P>0.05）。

结论

在正常中青年人群中，肱骨远端软骨厚度分布存在差异。双侧关节面软骨分布厚度无明显差异。关节面软骨厚度与年龄、性别、主力侧及工作类型无显著相关性。

关键词: 肱骨远端, 软骨, 双侧, 核磁

Background

The articular cartilage plays an exceedingly significant role in various aspects of the elbow joint, including flexion, extension, rotation, load-bearing, and force transmission. Changes in the anatomical parameters of the cartilage not only alter its biomechanical structure, leading to discomfort but also have a profound impact on elbow joint surgeries and articular anatomical reconstructions. Previous research has primarily focused on the two-dimensional "planarization" assessment of cartilage, lacking spatial-specific studies of the articular cartilage. Additionally, there is a lack of research concerning the distribution of articular cartilage in the bilateral elbow joints of young to middle-aged individuals. Consequently, the absence of evidence in selecting appropriate control templates for articular cartilage in patients' elbow joints contributes to uncertainty in current clinical treatments.

Objective

To evaluate the three-dimensional distribution of articular surface cartilage of distal humerus, compare the difference of articular cartilage distribution of bilateral elbow, and preliminarily analyze the risk factors affecting individual differences of articular cartilage.

Methods

The 3D-MRI scans of bilateral elbow joints from patients who visited our hospital between January 2021 and December 2022 were collected in our study, excluding those with osseous or cartilaginous structural abnormalities. A total of 36 subjects, comprising 17 females and 19 males, with an average age of 34.8 years (ranging from 23 to 45 years), were included, with 26 right-hand dominants. Subjects with no evidence of osteoarthritis were enrolled. Demographic information and imaging data of the enrolled subjects were collected. In DICOM format, the imaging data were transferred to MIMICS 21.0 software to establish a corresponding three-dimensional coordinate system. With the sagittal plane images perpendicular to the subchondral bone, measurements of cartilage thickness were conducted at multiple locations. The study aims to evaluate the distribution of articular cartilage thickness on the normal distal humeral joint surfaces in young to middle-aged individuals, assess the consistency of bilateral articular cartilage thickness, and analyze the factors influencing stress articular cartilage thickness.

Results

On the dominant side, the distal humeral articular cartilage was thickest at the 7 o'clock position of the humeral trochlea, measuring (1.54±0.39) mm, and thinnest at the 2 o'clock position of the lateral aspect of the capitellum, measuring (0.09±0.31) mm. On the non-dominant side, the cartilage was thickest at the 6 o'clock position of the lateral aspect of the capitellum, measuring (1.49±0.29) mm, and thinnest at the 11 o'clock position of the medial aspect of the trochlea, measuring (0.03±0.16) mm. A statistically significant difference existed between the cartilage distribution's thickest and thinnest points (dominant side: P< 0.01, non-dominant side: P< 0.01). The most remarkable difference in thickness between bilateral articular cartilage was (0.17±0.38) mm, showing no clinically significant statistical difference. Wilks' canonical correlation analysis revealed no statistically significant correlation between articular cartilage thickness within the joint surface domain and age, gender, dominant side, or occupational type (P>0.05) .

Conclusion

In the normal young and middle-aged population, there are differences in distal humeral articular cartilage thickness distribution. No significant differences are observed in the thickness distribution of articular cartilage between both sides of the joint. Additionally, articular cartilage thickness does not correlate significantly with age, gender, dominant side, or occupational type.

Key words: Distal humerus, Cartilage, Bilateral, MRI

图1 MRI中软骨测量位点　图A ：冠状面中选择的8个位置的矢状面；图B：矢状面中确定软骨测量点

表1 人口学特征（n=36）

指标	数值
年龄（岁）	34.8
男/女	19/17
主力侧（右）	26
工作性质
体力劳动者	8
运动员	7
办公人员	13
家务工作	8

表1 人口学特征（n=36）

指标	数值
年龄（岁）	34.8
男/女	19/17
主力侧（右）	26
工作性质
体力劳动者	8
运动员	7
办公人员	13
家务工作	8

图2 单一个体关节面不同位置的软骨厚度三维分布　图A：主力侧；图B：非主力侧

图3 单一个体肱骨远端软骨提取

表2 不同位置软骨厚度的平均值对比（mm，±s）

位置	侧别	肱骨小头外侧缘	肱骨小头中心点	肱骨小头内侧缘	肱骨滑车外侧缘	滑车外侧缘与滑车棘中点	滑车棘	滑车棘与滑车内侧缘中点	滑车内侧缘
2	非主力侧	0.28±0.55	0.66±0.56	1.03±0.66	1.13±0.35	0.91±0.26	0.90±0.38	1.00±0.40	0.51±0.50
	主力侧	0.09±0.31	0.33±0.46	1.09±0.50	0.96±0.44	1.00±0.25	0.93±0.29	0.90±0.42	0.66±0.48
3	非主力侧	0.61±0.66	1.02±0.38	1.17±0.57	1.31±0.44	1.17±0.35	1.05±0.28	1.12±0.34	0.85±0.37
	主力侧	0.42±0.58	0.84±0.52	1.22±0.41	1.28±0.29	1.22±0.26	1.08±0.21	1.20±0.24	0.89±0.45
4	非主力侧	0.81±0.60	1.07±0.29	1.30±0.40	1.34±0.33	1.25±0.49	1.10±0.27	1.13±0.24	0.96±0.21
	主力侧	0.87±0.59	1.10±0.26	1.14±0.25	1.28±0.38	1.31±0.34	1.10±0.28	1.15±0.22	1.06±0.29
5	非主力侧	1.13±0.41	1.07±0.23	1.29±0.33	1.33±0.40	1.20±0.42	1.15±0.36	1.14±0.19	1.05±0.25
	主力侧	1.16±0.39	1.16±0.26	1.20±0.25	1.32±0.42	1.35±0.33	1.15±0.29	1.20±0.24	1.14±0.22
6	非主力侧	1.49±0.30	1.26±0.42	1.36±0.34	1.44±0.39	1.35±0.38	1.20±0.35	1.20±0.22	1.12±0.29
	主力侧	1.41±0.29	1.25±0.34	1.30±0.33	1.43±0.36	1.44±0.36	1.27±0.28	1.33±0.34	1.24±0.33
7	非主力侧	1.39±0.40	1.29±0.35	1.48±0.48	1.38±0.35	1.36±0.41	1.17±0.41	1.27±0.16	1.08±0.29
	主力侧	1.35±0.31	1.35±0.34	1.39±0.35	1.54±0.39	1.40±0.36	1.34±0.35	1.29±0.23	1.13±0.33
8	非主力侧	1.32±0.31	1.25±0.32	1.34±0.34	1.35±0.35	1.17±0.28	1.13±0.28	1.20±0.24	0.87±0.48
	主力侧	1.30±0.31	1.32±0.38	1.29±0.32	1.45±0.39	1.30±0.27	1.23±0.41	1.20±0.44	1.03±0.50
9	非主力侧	1.33±0.37	1.21±0.29	1.23±0.31	1.21±0.47	1.13±0.33	1.08±0.33	1.13±0.41	0.84±0.58
	主力侧	1.24±0.25	1.15±0.40	1.30±0.27	1.39±0.33	1.24±0.41	1.15±0.34	1.07±0.52	0.72±0.55
10	非主力侧	0.79±0.49	0.92±0.41	1.02±0.45	0.96±0.45	0.86±0.35	0.71±0.39	0.79±0.46	0.37±0.47
	主力侧	0.89±0.45	0.90±0.44	0.94±0.46	1.00±0.57	1.03±0.40	0.96±0.37	0.90±0.48	0.30±0.47
11	非主力侧	0.29±0.49	0.50±0.46	0.17±0.42	0.42±0.54	0.57±0.45	0.50±0.62	0.35±0.49	0.03±0.16
	主力侧	0.16±0.35	0.30±0.41	0.16±0.40	0.26±0.44	0.62±0.44	0.54±0.51	0.48±0.63	0.13±0.37

表2 不同位置软骨厚度的平均值对比（mm，±s）

位置	侧别	肱骨小头外侧缘	肱骨小头中心点	肱骨小头内侧缘	肱骨滑车外侧缘	滑车外侧缘与滑车棘中点	滑车棘	滑车棘与滑车内侧缘中点	滑车内侧缘
2	非主力侧	0.28±0.55	0.66±0.56	1.03±0.66	1.13±0.35	0.91±0.26	0.90±0.38	1.00±0.40	0.51±0.50
	主力侧	0.09±0.31	0.33±0.46	1.09±0.50	0.96±0.44	1.00±0.25	0.93±0.29	0.90±0.42	0.66±0.48
3	非主力侧	0.61±0.66	1.02±0.38	1.17±0.57	1.31±0.44	1.17±0.35	1.05±0.28	1.12±0.34	0.85±0.37
	主力侧	0.42±0.58	0.84±0.52	1.22±0.41	1.28±0.29	1.22±0.26	1.08±0.21	1.20±0.24	0.89±0.45
4	非主力侧	0.81±0.60	1.07±0.29	1.30±0.40	1.34±0.33	1.25±0.49	1.10±0.27	1.13±0.24	0.96±0.21
	主力侧	0.87±0.59	1.10±0.26	1.14±0.25	1.28±0.38	1.31±0.34	1.10±0.28	1.15±0.22	1.06±0.29
5	非主力侧	1.13±0.41	1.07±0.23	1.29±0.33	1.33±0.40	1.20±0.42	1.15±0.36	1.14±0.19	1.05±0.25
	主力侧	1.16±0.39	1.16±0.26	1.20±0.25	1.32±0.42	1.35±0.33	1.15±0.29	1.20±0.24	1.14±0.22
6	非主力侧	1.49±0.30	1.26±0.42	1.36±0.34	1.44±0.39	1.35±0.38	1.20±0.35	1.20±0.22	1.12±0.29
	主力侧	1.41±0.29	1.25±0.34	1.30±0.33	1.43±0.36	1.44±0.36	1.27±0.28	1.33±0.34	1.24±0.33
7	非主力侧	1.39±0.40	1.29±0.35	1.48±0.48	1.38±0.35	1.36±0.41	1.17±0.41	1.27±0.16	1.08±0.29
	主力侧	1.35±0.31	1.35±0.34	1.39±0.35	1.54±0.39	1.40±0.36	1.34±0.35	1.29±0.23	1.13±0.33
8	非主力侧	1.32±0.31	1.25±0.32	1.34±0.34	1.35±0.35	1.17±0.28	1.13±0.28	1.20±0.24	0.87±0.48
	主力侧	1.30±0.31	1.32±0.38	1.29±0.32	1.45±0.39	1.30±0.27	1.23±0.41	1.20±0.44	1.03±0.50
9	非主力侧	1.33±0.37	1.21±0.29	1.23±0.31	1.21±0.47	1.13±0.33	1.08±0.33	1.13±0.41	0.84±0.58
	主力侧	1.24±0.25	1.15±0.40	1.30±0.27	1.39±0.33	1.24±0.41	1.15±0.34	1.07±0.52	0.72±0.55
10	非主力侧	0.79±0.49	0.92±0.41	1.02±0.45	0.96±0.45	0.86±0.35	0.71±0.39	0.79±0.46	0.37±0.47
	主力侧	0.89±0.45	0.90±0.44	0.94±0.46	1.00±0.57	1.03±0.40	0.96±0.37	0.90±0.48	0.30±0.47
11	非主力侧	0.29±0.49	0.50±0.46	0.17±0.42	0.42±0.54	0.57±0.45	0.50±0.62	0.35±0.49	0.03±0.16
	主力侧	0.16±0.35	0.30±0.41	0.16±0.40	0.26±0.44	0.62±0.44	0.54±0.51	0.48±0.63	0.13±0.37

图4 单一个体肱骨远端结果配准初步结果

表3 双侧软骨厚度分布差异的平均值（mm）

位置	肱骨小头外侧缘	肱骨小头中心点	肱骨小头内侧缘	肱骨滑车外侧缘	滑车外侧缘与滑车棘中点	滑车棘	滑车棘与滑车内侧缘中点	滑车内侧缘
2	0.20	0.33	-0.06	0.18	-0.09	-0.03	0.11	-0.14
3	0.19	0.19	-0.05	0.02	-0.05	-0.03	-0.07	-0.05
4	-0.07	-0.03	0.15	0.06	-0.06	0.00	-0.02	-0.10
5	-0.03	-0.08	0.09	0.01	-0.15	0.00	-0.06	-0.10
6	0.08	0.01	0.05	0.01	-0.09	-0.07	-0.13	-0.12
7	0.05	-0.06	0.09	-0.15	-0.04	-0.17	-0.02	-0.05
8	0.02	-0.07	0.05	-0.10	-0.13	-0.10	0.00	-0.15
9	0.09	0.05	-0.07	-0.18	-0.11	-0.07	0.06	0.11
10	-0.10	0.02	0.08	-0.04	-0.17	-0.25	-0.11	0.06
11	0.12	0.19	0.01	0.16	-0.05	-0.04	-0.14	-0.10

表3 双侧软骨厚度分布差异的平均值（mm）

位置	肱骨小头外侧缘	肱骨小头中心点	肱骨小头内侧缘	肱骨滑车外侧缘	滑车外侧缘与滑车棘中点	滑车棘	滑车棘与滑车内侧缘中点	滑车内侧缘
2	0.20	0.33	-0.06	0.18	-0.09	-0.03	0.11	-0.14
3	0.19	0.19	-0.05	0.02	-0.05	-0.03	-0.07	-0.05
4	-0.07	-0.03	0.15	0.06	-0.06	0.00	-0.02	-0.10
5	-0.03	-0.08	0.09	0.01	-0.15	0.00	-0.06	-0.10
6	0.08	0.01	0.05	0.01	-0.09	-0.07	-0.13	-0.12
7	0.05	-0.06	0.09	-0.15	-0.04	-0.17	-0.02	-0.05
8	0.02	-0.07	0.05	-0.10	-0.13	-0.10	0.00	-0.15
9	0.09	0.05	-0.07	-0.18	-0.11	-0.07	0.06	0.11
10	-0.10	0.02	0.08	-0.04	-0.17	-0.25	-0.11	0.06
11	0.12	0.19	0.01	0.16	-0.05	-0.04	-0.14	-0.10

表4 肘关节软骨空间分布的影响因素

集合	F值	P值
主力侧-人口学集合
1	0.757	0.784
2	0.544	0.937
3	0.463	0.952
4	0.392	0.934
非主力侧-人口学集合
1	1.265	0.323
2	0.732	0.790
3	0.320	0.993
4	0.142	0.999

表4 肘关节软骨空间分布的影响因素

集合	F值	P值
主力侧-人口学集合
1	0.757	0.784
2	0.544	0.937
3	0.463	0.952
4	0.392	0.934
非主力侧-人口学集合
1	1.265	0.323
2	0.732	0.790
3	0.320	0.993
4	0.142	0.999

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Three-dimensional distribution and bilateral registration of articular cartilage of distal humerus

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Three-dimensional distribution and bilateral registration of articular cartilage of distal humerus