本文選題：下肢骨骼　切入點(diǎn)：解剖學(xué)參數(shù)　出處：《第二軍醫(yī)大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：【研究背景】 目前,國(guó)外骨科內(nèi)固定材料是根據(jù)西方人正常骨與關(guān)節(jié)建立的解剖數(shù)據(jù)庫(kù)設(shè)計(jì)的。因我國(guó)尚未建立中國(guó)人群下肢的正常骨與關(guān)節(jié)周圍解剖數(shù)據(jù)庫(kù),國(guó)內(nèi)骨科器材生產(chǎn)企業(yè)生產(chǎn)的下肢不銹鋼和鈦金屬接骨板及螺釘,形式多為仿制國(guó)外產(chǎn)品,幾何形態(tài)不符合國(guó)人的骨關(guān)節(jié)解剖生理特點(diǎn)。為使下肢接骨板和螺釘?shù)脑O(shè)計(jì)更加符合國(guó)人骨和關(guān)節(jié)解剖生理特點(diǎn),有必要建立中國(guó)人群的下肢正常骨與關(guān)節(jié)周圍解剖形態(tài)學(xué)數(shù)據(jù)庫(kù)。以減少術(shù)中創(chuàng)傷,降低術(shù)后內(nèi)固定斷裂、松動(dòng)、脫落率,增加術(shù)后骨折愈合率。為國(guó)產(chǎn)下肢接骨板及螺釘?shù)脑O(shè)計(jì)、制造、力學(xué)分析、臨床應(yīng)用奠定基礎(chǔ)。 現(xiàn)在,傳統(tǒng)的影像學(xué)測(cè)量方法包括X線平片、CT平掃、MRI平掃及標(biāo)本中測(cè)量。X線平片測(cè)量雖然方便、直觀,但受測(cè)量角度、體位、距離等的影響較大,并且不能進(jìn)行三維立體解剖學(xué)測(cè)量,此次研究中利用X線平片測(cè)量股骨、脛骨、腓骨長(zhǎng)度,股骨、脛骨峽部長(zhǎng)度及皮質(zhì)骨緣切線角度。標(biāo)本因風(fēng)干等因素存在,測(cè)量誤差大,另外骨髓腔部位等數(shù)值不易測(cè)量。CT及MRI平掃為二維影像,亦不能進(jìn)行三維立體解剖學(xué)測(cè)量。 美國(guó)可視人計(jì)劃(1989)的出現(xiàn)推動(dòng)了數(shù)字化人與醫(yī)學(xué)圖像處理技術(shù)的研究,對(duì)數(shù)字醫(yī)學(xué)的發(fā)展有著深遠(yuǎn)意義,CT三維重建已成為成熟技術(shù),已廣泛應(yīng)用于臨床醫(yī)學(xué)。CT三維重建圖像具有傳統(tǒng)方法不可比擬的優(yōu)勢(shì),能從任意角度和方向觀察圖像,能夠正確標(biāo)記測(cè)量標(biāo)點(diǎn)減小測(cè)量誤差。因此,三維重建技術(shù)為本研究供新的思路與方法。 SQL Server 2008為超大型數(shù)據(jù)庫(kù)軟件,并且能通過(guò)互聯(lián)網(wǎng)進(jìn)行數(shù)據(jù)的輸入及查詢,此次研究樣本量小、測(cè)量項(xiàng)目有限,為今后建立大樣本、跨地域及多民族的國(guó)人下肢正常骨與關(guān)節(jié)周圍解剖學(xué)數(shù)據(jù)庫(kù)提供了平臺(tái)。 【研究目的】 在平片及CT三維重建影像學(xué)圖像中,測(cè)出下肢骨與關(guān)節(jié)周圍解剖學(xué)參數(shù)。對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,測(cè)出每個(gè)項(xiàng)目的均數(shù)及標(biāo)準(zhǔn)差,并將數(shù)據(jù)與西方人相比較,發(fā)現(xiàn)國(guó)人下肢解剖學(xué)參數(shù)與西方人有統(tǒng)計(jì)學(xué)差異。同時(shí)將測(cè)得數(shù)據(jù)及影像學(xué)圖像輸入SQL Server 2008數(shù)據(jù)庫(kù)軟件中,備查詢及應(yīng)用。 【方法】 1、研究對(duì)象及圖像采集 (1)150名志愿者來(lái)自長(zhǎng)期居住華東地區(qū),年齡19-73歲,平均52.8歲,志愿者為正常人或輕度膝關(guān)節(jié)退變,志愿者下肢均無(wú)畸形、無(wú)腫瘤、無(wú)骨折、無(wú)手術(shù)史。 (2)Philips DR機(jī)對(duì)150名志愿者行下肢股骨及脛腓骨全長(zhǎng)正側(cè)位平片攝片;TOHSIBA Aquilion C T掃描儀對(duì)150志愿者下肢髖、膝、踝關(guān)節(jié)行CT掃描。 2、CT三維圖像重建 在個(gè)人電子計(jì)算機(jī)平臺(tái)上,將髖、膝、踝關(guān)節(jié)CT平掃Dicom格式輸入Mimics 10.01軟件中,通過(guò)閾值分割、消除噪音、分離結(jié)構(gòu)及光滑圖像等步驟對(duì)關(guān)節(jié)周圍骨骼CT掃描數(shù)據(jù)行三維重建,并且可對(duì)三維圖像進(jìn)行任意旋轉(zhuǎn)、分割等操作。 3、數(shù)據(jù)測(cè)量 (1)將股骨、脛腓骨全長(zhǎng)正側(cè)位平片Dicom格式輸入Dicom Explorer軟件中直接測(cè)出股骨、脛骨、腓骨長(zhǎng)度,股骨、脛骨峽部(橫截面直徑相差不超過(guò)1mm)長(zhǎng)度,皮質(zhì)骨緣切線角度; (2)在髖、膝、踝關(guān)節(jié)CT三維圖像中測(cè)出關(guān)節(jié)周圍22個(gè)解剖學(xué)參數(shù),如:股骨頸頸干角、股骨髁寬、脛骨平臺(tái)寬等。 4、將數(shù)據(jù)輸入數(shù)據(jù)庫(kù)軟件中 將測(cè)得數(shù)據(jù)及影像學(xué)圖像輸入SQL Server 2008數(shù)據(jù)庫(kù)軟件中,備查詢及應(yīng)用。 【結(jié)果】 1、選SPSS15.0對(duì)測(cè)得解剖學(xué)參數(shù)進(jìn)行統(tǒng)計(jì)學(xué)分析,測(cè)得平均值及標(biāo)準(zhǔn)差。如:股骨長(zhǎng)(大轉(zhuǎn)子中點(diǎn)至股骨外髁距離)382.3±7.8 mm、股骨峽部橫徑25.0±0.8 mm、股骨頸頸干角129.1±6.5°、股骨髁寬70.8±5.1 mm、脛骨平臺(tái)寬68.2±4.6 mm。 2、以脛骨平臺(tái)內(nèi)翻角、脛骨平臺(tái)后傾角為例,與西方人解剖形態(tài)學(xué)參數(shù)行t檢驗(yàn),發(fā)現(xiàn)兩者間有統(tǒng)計(jì)學(xué)差異。 【結(jié)論】 1、CT三維重建測(cè)量與傳統(tǒng)的測(cè)量方法比較具有明顯優(yōu)勢(shì)。三維圖像不僅可以清晰、直觀地觀察,而且可以將各個(gè)部位切割、透視及旋轉(zhuǎn),能夠方便測(cè)量、減小測(cè)量誤差,為骨骼的解剖學(xué)測(cè)量提供了新的技術(shù)與方法。 2、SQL Server 2008為超大型數(shù)據(jù)庫(kù)軟件,不僅存儲(chǔ)量大,而且能通過(guò)網(wǎng)絡(luò)傳輸信息,方便數(shù)據(jù)輸入、查詢及應(yīng)用。由于本研究時(shí)間短,收集的樣本有限,SQL Server 2008數(shù)據(jù)庫(kù)軟件為今后建立包括國(guó)內(nèi)不同地域、不同民族的人體骨骼數(shù)據(jù)庫(kù)提供了平臺(tái)。 3、長(zhǎng)期臨床研究發(fā)現(xiàn),進(jìn)口內(nèi)固定器械及其仿制產(chǎn)品不能適合中國(guó)人群解剖生理特點(diǎn),建立中國(guó)人的下肢正常骨與關(guān)節(jié)周圍解剖數(shù)據(jù)庫(kù)的重要性越來(lái)越突出。數(shù)據(jù)庫(kù)建立后,通過(guò)計(jì)算機(jī)輔助設(shè)計(jì)(CAD)及計(jì)算機(jī)輔助制造(CAM)制造出更加適合國(guó)人生理結(jié)構(gòu)的接骨板和螺釘。另一方面,可以輔助手術(shù)治療、輔助臨床教學(xué),并且能進(jìn)一步行下肢骨骼生物力學(xué)分析。
[Abstract]:[research background]
At present, foreign department of orthopedics fixation material is based on the normal anatomy of the bone and joint of Westerners to establish database design. Because of the surrounding normal bone and joint China has not yet established a China population lower extremity anatomy database, lower extremity stainless steel and titanium metal plates and bolts domestic Department of orthopedics equipment production enterprises and production, mostly in the form of imitation of foreign products, geometry not in conformity with the anatomical and physiological characteristics of bone and joint of the people. In order to make the design of lower limb bone plate and screw accords with the physiological characteristics of bone and joint anatomy of lower extremity, normal bone and joint around the need to establish China population morphology database. In order to reduce intraoperative trauma, reduce postoperative internal fixation of fracture, loosening, expulsion rate. Increase the postoperative healing rate. Analysis of domestic design, lower limb bone plate and screw manufacturing, mechanical, lay the foundation for clinical application.
Now, the traditional measuring methods including X-ray imaging, CT scan, MRI scan and measurement samples. X Xianping measurement is convenient, intuitive, but by measuring angle, position, influence distance is larger, and not three-dimensional images, X-ray film measurement using the femur in the study the length of tibia, fibula, femur, tibia length and isthmus cortical bone cutting edge angle. Because of factors such as air dried samples, measurement error, numerical in marrow cavity position is not easy to measure.CT and MRI scan two-dimensional images, they are not three-dimensional anatomical measurement.
American visible human project (1989) appears to promote the study of medical image processing and digital technology, has far-reaching significance to the development of digital medicine, CT three-dimensional reconstruction has become a mature technology, has been widely used in clinical medicine.CT 3D reconstruction image has the incomparable advantage of traditional methods, and can observe the image from the direction of any angle can reduce the measurement error of measuring mark correctly labeled. Therefore, 3D reconstruction technology as a new idea and method for this study.
SQL Server 2008 is a very large database software, and through the Internet for data input and query, the small sample size, measurement project Co., for the future establishment of a large sample of Chinese people, the normal limb bone and joint anatomy around database cross regional and multi nationalities provides a platform.
[purpose]
In the flat image 3D reconstruction and CT imaging, measure the lower limb bone and joint surrounding anatomical parameters. The data were statistically analyzed and measured each item of mean and standard deviation and the data compared with westerners, Chinese people found lower extremity anatomy parameters and Westerners have statistical difference. At the same time the measured data and the images are inputted into the SQL Server 2008 database software, the preparation and application of the query.
[method]
1, research object and image acquisition
(1) 150 volunteers came from East China, aged 19-73 years, with an average age of 52.8 years. Volunteers were normal or mild knee degeneration. Volunteers had no deformity in their lower limbs, no tumors, no fractures and no operative history.
(2) Philips DR machine was used for 150 volunteers to perform the anteroposterior lateral radiograph of the femur and tibia and fibula. The TOHSIBA Aquilion C T scanner performed CT scan on 150 volunteers' lower extremities, knees and ankles.
2, CT 3D image reconstruction
In the personal computer platform, the hip, knee, ankle joint CT scan Dicom format into Mimics 10.01 software, the elimination of noise by threshold segmentation, separation, structure and smooth image steps of bone around the joint CT scan data for 3D reconstruction, and the three-dimensional image of arbitrary rotation, segmentation and other operations.
3, data measurement
(1) direct femur, tibia, fibula length, femur and tibial isthmus (cross section diameter no more than 1mm) length and cortical bone edge tangent angle were directly input into Dicom, Dicom and Explorer format of femur, tibia and fibula.
(2) 22 anatomical parameters around the joint were detected in the CT three-dimensional images of the hip, knee, and ankle joint, such as the dry angle of the neck and neck of the femur, the width of the femoral condyle, the width of the tibial plateau and so on.
4, input the data into the database software
The data and image images are input into the SQL Server 2008 database software to prepare the query and application.
[results]
1, SPSS15.0 statistical analysis of the measured anatomic parameters, measured the average value and standard deviation. Such as: the femur length (greater trochanter midpoint to the femoral condyle distance) 382.3 + 7.8 mm, the isthmus diameter of 25 + 0.8 mm, femoral neck shaft angle of 129.1 plus or minus 6.5 degrees, the femoral condyle width 70.8 + 5.1 mm, tibial plateau width of 68.2 + 4.6 mm.
2, with the tibial plateau angle and the tibial plateau tilt angle as an example, the t test with the anatomical morphological parameters of the Westerners found that there was a statistical difference between the two.
[Conclusion]
1, compared with the traditional method of measuring 3D CT reconstruction has obvious advantages. The 3D image can not only clear, direct observation, but also to various parts of the cutting, perspective and rotation, can reduce the measuring error, convenient measurement, provides a new technology and method for the measurement of bone anatomy.
2, SQL Server 2008 is a very large database software, not only a large amount of storage and transmission through the network information, convenient data input, query and application. Because the study time is short, the collection of samples is limited, SQL Server 2008 database software for the future establishment of domestic different regions, different ethnic groups of the human skeleton database provides platform.
3, long-term clinical studies found that the internal fixation devices and imported generic products are not suitable for Chinese anatomical and physiological characteristics, the importance of establishing the normal limb bone and periarticular Chinese anatomical database is becoming more and more prominent. After the establishment of the database, the computer aided design (CAD) and computer aided manufacturing (CAM) to create a more suitable plate and screw in human physiological structure. On the other hand, can be assisted surgical treatment, clinical teaching, and can further lower limb bone biomechanical analysis.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：TP311.13;R322.7

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