發(fā)布時(shí)間：2018-01-06 22:33

  本文關(guān)鍵詞：計(jì)算機(jī)處理距骨骨軟骨損傷MRI圖像測(cè)定壞死體積及體外沖擊波治療的療效分析　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 核磁共振成像 三維模型 ESWT OLT AOFAS評(píng)分

【摘要】：目的:依據(jù)T1加權(quán)相矢狀位MRI圖像數(shù)據(jù),計(jì)算機(jī)上重構(gòu)出體外沖擊波治療前后距骨骨軟骨損傷(OLT)的三維模型,直觀化明確軟骨損傷部位,并計(jì)算得出軟骨損傷的體積,比較體外沖擊波治療OLT的前后變化,探討其療效及臨床應(yīng)用意義。方法:24例(30踝)早中期OLT患者,男16例,女8例,平均年齡37.5歲(18~57歲)。病程4~13個(gè)月,平均6.5個(gè)月。所有患者均有一側(cè)或雙側(cè)踝關(guān)節(jié)扭傷病史,左側(cè)12例,右側(cè)18例。Hepple分期[1]:I期7踝,II期12踝,III期11踝�；颊呔胁煌潭鹊孽钻P(guān)節(jié)腫脹、疼痛,伴有一定程度跛行,負(fù)重或活動(dòng)后疼痛加重,踝關(guān)節(jié)活動(dòng)僵硬伴有功能障礙。踝關(guān)節(jié)X線片僅有局部骨密度影增高或無(wú)明顯變化,尚未出現(xiàn)距骨的塌陷。一側(cè)或雙側(cè)踝關(guān)節(jié)MRI T1加權(quán)相上距骨表面顯示斑片狀低信號(hào)區(qū)。有時(shí)T1加權(quán)相可見(jiàn)線樣狀低信號(hào),T2加權(quán)相顯示低信號(hào)內(nèi)出現(xiàn)高信號(hào)線,即“雙線征”。其中大部分患者曾經(jīng)接受過(guò)保守治療,包括制動(dòng)、理療、口服藥物、局部類(lèi)固醇注射等,但治療后效果不佳。每位患者體外沖擊波治療前及治療3個(gè)療程后進(jìn)行一側(cè)或雙側(cè)踝關(guān)節(jié)MRI檢查,薄層厚度(Thick)為2mm,踝關(guān)節(jié)MRI矢狀位T1加權(quán)相圖像以DICOM格式數(shù)據(jù)保存。利用Mimics軟件的圖像處理功能形成預(yù)處理文件,運(yùn)用Adobe Photoshop圖像編輯軟件分別描繪出距骨區(qū)域及其骨軟骨損傷區(qū)域的范圍。依靠Magics實(shí)體造型軟件重構(gòu)出相應(yīng)的骨軟骨損傷部位及距骨的三維立體模型,采用體積測(cè)算模塊功能計(jì)算并讀取距骨及骨軟骨損傷區(qū)域的體積,依據(jù)相應(yīng)的公式計(jì)算得到距骨骨軟骨損傷區(qū)域的百分比。采用骨科發(fā)散式ESWT治療機(jī)按療程進(jìn)行治療,按照臨床納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選出的患者,治療前均進(jìn)行VAS評(píng)分及AOFAS評(píng)分。按照OLT患者M(jìn)RI的Hepple分期結(jié)合AOFAS評(píng)分標(biāo)準(zhǔn)分為輕度、中度、重度三組。設(shè)定ESWT同樣的能量參數(shù),對(duì)患者進(jìn)行3個(gè)療程規(guī)律的ESWT治療,療程間歇期間指導(dǎo)患者進(jìn)行一定的功能鍛煉。3個(gè)療程結(jié)束后對(duì)患者再次進(jìn)行VAS評(píng)分及A0FAS評(píng)分,并根據(jù)相應(yīng)的療效評(píng)分結(jié)果,得出ESWT治療早中期OLT患者的優(yōu)良率。收集并整理數(shù)據(jù),圖表觀察分布情況,統(tǒng)計(jì)學(xué)進(jìn)行數(shù)據(jù)分析。利用SPSS13.0分析軟件對(duì)實(shí)驗(yàn)最終數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,結(jié)果以均數(shù)±標(biāo)準(zhǔn)差表示,并采用配對(duì)樣本t檢驗(yàn)分析。結(jié)果:重構(gòu)的三維距骨模型上可見(jiàn)骨軟骨損傷區(qū)域位于前外側(cè)穹窿部或后內(nèi)側(cè)穹窿部。計(jì)算機(jī)上測(cè)得整個(gè)距骨的體積、ESWT治療前骨軟骨損傷區(qū)域的體積、治療3個(gè)療程后骨軟骨損傷區(qū)域的體積。根據(jù)相應(yīng)的療效評(píng)分結(jié)果,得出ESWT治療早中期OLT患者的優(yōu)良率。其中ESWT治療輕、中度患者有明顯的療效,對(duì)于重度患者緩解急性疼痛癥狀有較好的作用。3個(gè)療程治療結(jié)束后,VAS評(píng)分明顯降低,AOFAS評(píng)分顯著升高,與治療前對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:利用計(jì)算機(jī)進(jìn)行MRI圖像的三維重建可以重構(gòu)出OLT三維模型,幫助臨床醫(yī)師直觀、精確地觀察OLT病灶的形狀和位置。能夠準(zhǔn)確地計(jì)算損傷病灶的體積,其結(jié)果可信。ESWT可對(duì)早中期OLT患者具有干預(yù)控制作用,研究表明能夠達(dá)到延緩及減輕病灶發(fā)展的作用,因而ESWT可作為治療早中期OLT疾病的有效方法之一。
[Abstract]:Objective: Based on the T1 weighted sagittal MRI image data, reconstruct the extracorporeal shock wave before and after the treatment of osteochondral lesions of the talus computer (OLT) of the 3D model, intuitive clear cartilage injury site, and calculated the volume of cartilage injury, comparison of extracorporeal shock wave changes before and after the treatment of OLT, to investigate the clinical significance and its application the curative effect. Methods: 24 cases (30 ankle) early stage OLT patients, 16 were male, 8 were female, the average age of 37.5 years (18~57 years). The duration of 4~13 months, average 6.5 months. All patients had unilateral or bilateral ankle sprain history, 12 cases on the left side, right side 18 cases of stage [1]:.Hepple I 7 II 12 ankle, ankle, ankle. 11 stage III patients had different degree of ankle joint swelling, pain, accompanied by a certain degree of lameness, increased pain or weight-bearing activity after ankle stiffness accompanied by dysfunction. Bone density of ankle radiographs only increased or had no significant change in bureau of the Ministry of, Has not yet appeared talar collapse. Unilateral or bilateral ankle MRI T1 weighted on the talus surface showed patchy low signal area. Sometimes T1 weighted visible line like low signal, T2 weighted phase showed high signal in the low signal, namely "double line sign". Most of these patients had received conservative treatment, including brake, physical therapy, oral medication, local steroid injections, but after treatment ineffective. Each patient in vitro shock wave therapy before and after 3 courses of treatment for unilateral or bilateral ankle joint MRI examination, thin layer thickness (Thick) of 2mm, MRI of ankle sagittal T1 weighted image in DICOM format data. Using Mimics software image processing function to form the preprocessed file, using Adobe Photoshop image editing software are respectively described the scope of talar osteochondral injury area and its area. Relying on Magics solid modeling software constructs corresponding The three-dimensional model of bone and cartilage injury and talus, using the volume measurement module function calculation and read the talus and osteochondral lesions of the volume of the region, on the basis of the corresponding formula percentage of osteochondral lesions of the talus area. The Department of orthopedics divergent ESWT treatment machine according to the course of treatment, according to clinical inclusion criteria and exclusion criteria selected the patients before the treatment, VAS score and AOFAS score. According to OLT MRI of patients with Hepple staging with AOFAS standard for evaluation is divided into mild, moderate and severe three groups. ESWT the same set of energy parameters, ESWT treatment for 3 courses of patients, during the course of intermittent guide patients over certain functional exercise.3 after a course of treatment of patients with VAS score and A0FAS score again, and according to the corresponding clinical score results, that ESWT treatment of early stage OLT patients. The excellent rate of collection And the data and charts to observe the distribution, statistical analysis of data. The statistical analysis of the experimental data using SPSS13.0 analysis software, the mean standard deviation, and using paired samples t test analysis. Results: the three-dimensional model reconstruction on the talus bone cartilage damage area is located in the anterolateral or posterior fornix fornix the inner side of the computer. The measured volume of the talus, ESWT before the treatment of osteochondral lesions of the volume of the region, the volume of bone and cartilage injury region after 3 courses of treatment. The curative effect according to the corresponding score results, obtained ESWT treatment of early stage OLT patients. The excellent rate of ESWT has obvious curative effect in treatment of mild, moderate patients. For patients with severe acute pain relief symptoms over a course of treatment and good effect of.3, VAS score decreased significantly, AOFAS score increased significantly, with statistical difference compared with before treatment Significance (P0.05). Conclusion: three dimensional reconstruction of MRI images by computer can reconstruct the 3D OLT model, help the clinician intuitively, accurately observed the shape and location of lesions. OLT can accurately calculate injury lesion volume, the result has control effect on early stage intervention in patients with OLT can be trusted.ESWT, study shows to delay and reduce the lesion development, so ESWT can be treated as one of the effective methods to early metaphase OLT disease.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R681.3;R445.2

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本文編號(hào)：1389820