本文關(guān)鍵詞：640層動態(tài)容積CT對正常人與髕股關(guān)節(jié)對合不良患者的髕骨運動軌跡的對比性研究，由筆耕文化傳播整理發(fā)布。

        本課題分為兩部分,第一部分研究640層CT運動成像在正常人髕骨運動軌跡的中的應(yīng)用價值；第二部分研究640層動態(tài)容積CT運動成像對髕股關(guān)節(jié)對合不良患者的應(yīng)用價值,并將所得到的數(shù)據(jù)與第一部分得到的正常人的髕骨運動軌跡進(jìn)行對比第一部分640層動態(tài)容積CT掃描對正常人髕骨運動軌跡的應(yīng)用價值目的在非負(fù)重狀態(tài)下,采用640層動態(tài)容積CT運動掃描成像技術(shù)在正常人髕骨運動軌跡的動態(tài)連續(xù)運動變化中的應(yīng)用價值,為髕股關(guān)節(jié)對合不良的病人的診斷,提供一定正常值的參考標(biāo)準(zhǔn)。材料和方法研究對象：前瞻性納入2013年9月～11月九龍醫(yī)院共20例正常人,其中男15例,女5例,年齡18～51歲,平均35.95歲,取被檢查者雙側(cè)膝關(guān)節(jié),故為40只膝關(guān)節(jié)。所有人均用Toshiba Aquilion one640層動態(tài)容積CT進(jìn)行髕骨運動軌跡的連續(xù)掃描。兩種測量方法：被檢查者仰臥于CT檢測床上,將兩側(cè)膝關(guān)節(jié)放于測量臺上,固定受檢者雙側(cè)膝關(guān)節(jié)的內(nèi)、外上髁,調(diào)整2點連線平行于測量臺；通過調(diào)整體位固定股骨頭幾何中心和內(nèi)、外上髁中點的連線平行于測量臺,取膝關(guān)節(jié)全伸位為測量起始點。具體的方法如下：(1)分別于膝關(guān)節(jié)屈曲角度為30°時,測量髕骨適合角、髕骨外側(cè)角、髕股指數(shù)、股骨滑車角及髕骨高度這5組數(shù)據(jù)的值。(2)640層動態(tài)容積CT對40只膝關(guān)節(jié)行動態(tài)容積掃描,全伸位建立3D坐標(biāo),坐標(biāo)原點為髕骨中心點,掃描時間共為13s,我們可以得到膝角為0°～60°時的膝關(guān)節(jié)的運動軌跡,并分析膝關(guān)節(jié)穩(wěn)定性的3D坐標(biāo)值。結(jié)果共計測量40只正常人的膝關(guān)節(jié),所得結(jié)果如下：1.正常人膝關(guān)節(jié)的髕股關(guān)節(jié)穩(wěn)定性的分級結(jié)果為：Ⅰa級4個(10%),Ⅰb級2個(5%),Ⅳa級24個(60%),Ⅳb級10個(25%),Ⅰc、Ⅳc、Ⅱ、Ⅲ級皆為0個。2.隨著膝角在0°-10°之間時,髕骨在X軸上輕度向內(nèi)側(cè)移動,而后隨著膝角的變化(20°～60°),髕骨持續(xù)不斷的向外側(cè)移位；隨著膝關(guān)節(jié)角度的變化(0。-60。),在Y軸(矢狀位)上,髕骨持續(xù)不斷的向下滑行；髕骨在Z軸的運動軌跡,隨著膝關(guān)節(jié)屈曲角度的變化,髕骨滑行的軌跡總體是向后的。初始階段,髕骨的運動幅度變化不大,隨著膝關(guān)節(jié)角度的變化,其中于50。-60。時,髕骨的滑行幅度達(dá)到最大。結(jié)論640層動態(tài)容積CT不僅可以提供傳統(tǒng)的診斷髕股關(guān)節(jié)穩(wěn)定性所要的數(shù)值,而且能夠提供髕骨運動軌跡的的三維坐標(biāo)值,為臨床診斷髕股關(guān)節(jié)穩(wěn)定性提供更加全面的資料。第二部分640層動態(tài)容積CT掃描對髕股關(guān)節(jié)對合不良患者的髕骨運動軌跡的應(yīng)用價值目的：在非負(fù)重狀態(tài)下,運用640層動態(tài)容積CT成像技術(shù),討論髕股關(guān)節(jié)對合不良病人的髕骨運動軌跡的應(yīng)用價值,將正常人髕骨運動軌跡與髕股關(guān)節(jié)對合不良病人的髕骨運動軌跡進(jìn)行對照分析。材料和方法：收集2013年9月～11月九龍醫(yī)院髕股關(guān)節(jié)對合不良的病人20例,男9例,女11例,年齡18～55歲,平均33.55歲,取病人雙側(cè)膝關(guān)節(jié),共40只膝關(guān)節(jié)。具體的測量方法及統(tǒng)計學(xué)方法與第一部分相同。結(jié)果：髕股關(guān)節(jié)對合不良病人的膝關(guān)節(jié)共計40只：(1).所得到的40只髕股關(guān)節(jié)對合不良病人的膝關(guān)節(jié)穩(wěn)定性的分級結(jié)果為：Ⅰa級9個(22.5%),Ⅰb級25個(62.5%),Ⅰc級3個(7.5%),Ⅲb級2個(5%),Ⅳa級1個(2.5%),余Ⅳb-c、Ⅱ、 Ⅲa、c級皆為0個。2.隨著膝關(guān)節(jié)屈曲角度由0°～60°之間變化,髕骨持續(xù)不斷的向內(nèi)側(cè)移位；在Y軸上隨著膝角的變化(0。-60。),髕骨的運動軌跡像正常人的運動軌跡一樣持續(xù)不斷的向下滑行；在Z軸上,隨著膝曲角度的變化,髕骨滑行的軌跡是顯著向前的。結(jié)論：將正常人和髕股關(guān)節(jié)對合不良患者的傳統(tǒng)膝關(guān)節(jié)穩(wěn)定性的測量值進(jìn)行對比及兩者的髕骨運動軌跡在三維坐標(biāo)軸中的數(shù)值進(jìn)行對比,可以得知,640層動態(tài)容積CT掃描成像不僅能像傳統(tǒng)的膝關(guān)節(jié)測量值那樣判斷髕股關(guān)節(jié)的穩(wěn)定性,而且可提供更加精確的坐標(biāo)值,為臨床對髕股關(guān)節(jié)穩(wěn)定性的診斷提供提供更為全面的診斷方法和依據(jù)。

    The study was divided into two parts:(1) to discuss the application value of patellartracking in healthy human using volume scan on sensation640slices CT.(2) to discuss theapplication value of patellar tracking in patient with patellofemoral malalignment usingvolume scan on sensation640slices CT. The results obtained were compared with rusultswhich got in part one.Part I An application value of tracking movement of normal patellarusing volume scan on sensation640slices CT.Objective: In the condition of non weight bearing, to discuss the application value of usingthe technology of the volume scan on sensation640slices CT healthy human for patellartracking, and to provide the range and foundation of normal vulue for patient withpatellofemoral malalignment.Materials and Methods:Research objects: The prospective pilot study enrolled20healthy human beings inKowloon Hospital from2013.9to2013.11, including15men and5women. The ageranged18~51with average of35.95years old. Both sides of the knee joint of allparticipantors (40of the knee joint in all) were examined. All the human beings receivedexamination by using volume scan on Toshiba Aquilion one sensation640slices CT.Two different methods of measuring: The participantors lay on the examining table onsensation640slices CT and put both sides of the knee on the measuring table. The femoralepicondylar of healthy human were fastened to measuring table, which was parallel tofemoral epicondylar axis. By adjusting the center of whirlbone and the midpoint of the lineof medial and lateral, we could let knee joint be parallel to the measurement station. Theposition of knee extension was the starting point to measure the instability of the knee joint. The specific methods were as follows:(1).When the knee angle was30°，We couldobtain the numeric of the femoral trochlear angle、Congruence angle、Lateralpatellofermoral angle、patellofemoral index and patellar height.(2).Data of dynamic scansof40knees was collected by using volume scan on sensation640slices CT. when the kneeangle was0°，we could establish the3D coordinate with the origin of coordinates was thecenter of the patella. The data of movement of the patellorfemoral joint was obtainedduring flexion (from0°to60°) within12s by320CT from all human beings. The3Dcoordinate of the center of patella was got to analyse the dispose relation of thepatellorfemoral joint.Results: Totally40knee-joints were measured. The results were as follows:(1).Thepatellofemoral joint stability of results of the classification for the healthy human were asfollows: Ⅰa was4（10%），Ⅰb was2（5%），Ⅳa was24（60%）， Ⅳb was10（25%），Ⅰc、Ⅳc、Ⅱ、Ⅲ was also0.(2).When the knee flexion reached0°~10°，the patellar movement was an inward movement along the X-axis, andsubsequently moved to the opposite lateral direction ever since with the knee anglechanged from20°to60°.When the knee angle changed from0°to60°，the patella movedconstantly along the Y-axis direction down. In the Z-axis, the patellar tracking was alwaysan backward movement.At first, the ranges of patellar motion was no big change. As theknee angle changed from50°to60°，the patellar movement reached the largest range.Conclusion:The functional imaging of640slices CT not only provide the conventionalnumeric which can diagnose the stability of the Patellofemoral joint, but also get the threedimensional coordinate values to provide the clinician more comprehensive information todiagnose the involution of patellofemoral joint.PartⅡ An application value of tracking movement of patients withpatellofemoral malalignment using volume scan on sensation640slices CT.Objective: In the condition of non weight bearing, to discuss the application value ofpatellar tracking in patients with patellofemoral malalignment using volume scan onsensation640slices CT, we could compare and analyze with the results which obtained in part one.Materials and Methods: The prospective pilot study enrolled20patients withpatellofemoral malalignment in Kowloon Hospital from2013.9to2013.11, including9men and11women. The age ranged18-55with average of35.55years old. Both sides ofthe knee joint of all participantors (totally40the knee joint) were examined. All thehuman beings received examination by using volume scan on Toshiba Aquilion onesensation640slices CT. The specific measuring and statistical method was the same as thepart I.Results: Totally40knee-joints were measured. The results were as follows:(1).Thepatellofemoral joint stability of results of the classification for the patients withpatellofemoral malalignment were as follows: Ⅰa was9（22.5%），Ⅰb was25（62.5%），Ⅰc was3(7.5%),Ⅲb was2(5%),Ⅳa was1（2.5%）.Ⅳb、c、Ⅱ、Ⅲa、c was also0.(2).When the knee flexion reached0°-60°，the patellarmovement was an inward constantly movement along the X-axis. With the knee anglechanged from0°to60°，，the patella moved along the Y-axis direction down as the healthyhuman. In the Z-axis, the patellar tracking was always an backward significant movement.Conclusion: The traditional measurements and3D coordinate values were contrastedbetween healthy human and patients with patellofemoral malalignment. We know that thefunctional imaging scan of640slices CT not only provide the conventional numeric whichcan diagnose the stability of the Patellofemoral joint, but also get the more accuratecoordinate values to provide the clinician the new method and foundation to diagnose theinvolution of patellofemoral joint.

640層動態(tài)容積CT對正常人與髕股關(guān)節(jié)對合不良患者的髕骨運動軌跡的對比性研究

中文摘要4-7Abstract7-9引言11-13第一部分 640層動態(tài)容積CT對正常人髕骨運動軌跡的應(yīng)用價值13-22    材料和方法13-16    結(jié)果16-18    討論18-22第二部分 640層動態(tài)容積CT對髕股關(guān)節(jié)對合不良病人的髕骨運動軌跡的應(yīng)用價值22-29    材料和方法22-23    結(jié)果23-26    討論26-29參考文獻(xiàn)29-32結(jié)論32-33附圖33-37綜述37-48    參考文獻(xiàn)44-48中英文縮略詞表48-49攻讀學(xué)位期間公開發(fā)表的論文49-50致謝50-51

  本文關(guān)鍵詞：640層動態(tài)容積CT對正常人與髕股關(guān)節(jié)對合不良患者的髕骨運動軌跡的對比性研究，由筆耕文化傳播整理發(fā)布。