數(shù)字化國(guó)人膝關(guān)節(jié)形態(tài)學(xué)測(cè)量在人工膝關(guān)節(jié)領(lǐng)域的應(yīng)用研究
發(fā)布時(shí)間：2018-07-28 12:59
【摘要】： 目的:隨著中國(guó)人口的不斷老齡化以及老年人膝關(guān)節(jié)的退行性改變,使得國(guó)人人工膝關(guān)節(jié)置換手術(shù)變得越來(lái)越普遍,因此人工膝關(guān)節(jié)置換術(shù)后的成功率和人工膝關(guān)節(jié)假體的使用壽命也就成為了人們關(guān)注的重點(diǎn)。人工膝關(guān)節(jié)置換手術(shù)是一項(xiàng)精確的手術(shù),在人工膝關(guān)節(jié)置換手術(shù)中,精確的截骨量、截骨角度以及假體的形態(tài)學(xué)匹配度是影響人工膝關(guān)節(jié)置換手術(shù)成功的關(guān)鍵。本研究通過(guò)對(duì)正常國(guó)人膝關(guān)節(jié)CT掃描,掃描圖像的三維重建,以及重建膝關(guān)節(jié)模擬人工膝關(guān)節(jié)置換手術(shù)進(jìn)行脛骨近端和股骨遠(yuǎn)端的截骨、形態(tài)學(xué)測(cè)量和統(tǒng)計(jì)分析,比較國(guó)人膝關(guān)節(jié)形態(tài)學(xué)大小與國(guó)內(nèi)外目前使用的膝關(guān)節(jié)形態(tài)尺寸之間的差異,同時(shí)進(jìn)行國(guó)人人工膝關(guān)節(jié)形態(tài)的大小設(shè)計(jì),為指導(dǎo)適合國(guó)人人工膝關(guān)節(jié)的生產(chǎn)提供形態(tài)學(xué)依據(jù)。 方法:通過(guò)CT掃描收集120個(gè)正常國(guó)人—志愿者膝關(guān)節(jié)的CT掃描圖像,應(yīng)用三維重建軟件進(jìn)行國(guó)人膝關(guān)節(jié)掃描圖像的三維重建,建立數(shù)字化國(guó)人膝關(guān)節(jié)模型,對(duì)重建膝關(guān)節(jié)三維模型模擬人工膝關(guān)節(jié)置換手術(shù),在內(nèi)側(cè)脛骨平臺(tái)下方6mm保持7度后傾角進(jìn)行膝關(guān)節(jié)脛骨近端截骨,在股骨遠(yuǎn)端內(nèi)側(cè)髁最低點(diǎn)上方9mm保持6度外翻角進(jìn)行股骨遠(yuǎn)端截骨,測(cè)量截骨斷面的前后徑(AP)、左右徑(ML)及其它主要的相關(guān)參數(shù),對(duì)測(cè)量結(jié)果進(jìn)行統(tǒng)計(jì)分析,并與國(guó)內(nèi)外使用的部分人工關(guān)節(jié)假體形態(tài)尺寸進(jìn)行比較,觀察假體形態(tài)與國(guó)人膝關(guān)節(jié)形態(tài)的差距。根據(jù)相關(guān)測(cè)量統(tǒng)計(jì)數(shù)據(jù)進(jìn)行國(guó)人人工膝關(guān)節(jié)的形態(tài)設(shè)計(jì),在形態(tài)學(xué)上為國(guó)人人工膝關(guān)節(jié)的設(shè)計(jì)提供理論依據(jù)。 結(jié)果:通過(guò)CT掃描收集到正常國(guó)人膝關(guān)節(jié)CT圖像120套,掃描范圍為膝關(guān)節(jié)的關(guān)節(jié)線以上20cm,關(guān)節(jié)線以下20cm。重建出120例正常國(guó)人的膝關(guān)節(jié)三維模型。模擬人工膝關(guān)節(jié)置換手術(shù)并進(jìn)行了脛骨近端和股骨遠(yuǎn)端的截骨,在截骨斷面進(jìn)行了形態(tài)學(xué)測(cè)量,國(guó)人脛骨近端形態(tài)學(xué)測(cè)量結(jié)果:男性脛骨左右徑(tML)為75.9±2.9mm,脛骨前后徑(tAP)為52±2.2mm,兩者的相關(guān)系數(shù)為0.50;女性脛骨左右徑(tML)為69.9±2.7mm,前后徑(tAP)為46.5±2.1mm,兩者的相關(guān)系數(shù)為0.57;總體脛骨左右徑(tML)為72.9±4.5mm,脛骨前后徑(tAP)為49.6±3.5mm,兩者的相關(guān)系數(shù)為0.82。 120例國(guó)人股骨遠(yuǎn)端截骨斷面形態(tài)學(xué)測(cè)量結(jié)果:男性股骨左右徑為(fML)為74.9±2.9mm,股骨前后徑(fAP)為66.6±2.4mm,兩者的相關(guān)系數(shù)為0.52;女性股骨左右徑(fML)為67.1±3.2mm,股骨前后徑(fAP)為61.6±2.9mm,兩者的相關(guān)系數(shù)為0.63;總體股骨左右徑為(fML)為71.5±4.9mm,股骨前后徑(fAP)為64.3±3.7mm,兩者的相關(guān)系數(shù)為0.80。 結(jié)論:國(guó)人膝關(guān)節(jié)脛骨近端tML和tAP具有較強(qiáng)的相關(guān)性,其中總體相關(guān)性要強(qiáng)于男性和女性個(gè)體相關(guān)性(男性為0.50,女性為0.57,總體為0.82)。其形態(tài)大小與國(guó)內(nèi)使用的部分人工關(guān)節(jié)假體相比,結(jié)果發(fā)現(xiàn)假體種類中Scopio,PFC Sigma與國(guó)人膝關(guān)節(jié)形態(tài)匹配度較好,其他假體尺寸與國(guó)人膝關(guān)節(jié)的形態(tài)學(xué)存在著一定的差距。股骨遠(yuǎn)端fML和fAP具有較強(qiáng)的相關(guān)性,其中總體相關(guān)性要強(qiáng)于男性和女性個(gè)體相關(guān)性(男性為0.52,女性為0.63,總體為0.80)。其形態(tài)大小與國(guó)內(nèi)使用的部分人工關(guān)節(jié)假體相比,結(jié)果發(fā)現(xiàn)在五種人工膝關(guān)節(jié)假體中只有NexGen與國(guó)人膝關(guān)節(jié)形態(tài)匹配度較好,其余人工膝關(guān)節(jié)假體與國(guó)人膝關(guān)節(jié)形態(tài)存在一定差距。 因總體相關(guān)性強(qiáng)于個(gè)體,因此在人工關(guān)節(jié)的設(shè)計(jì)中應(yīng)將整個(gè)國(guó)人作為總體,同時(shí)結(jié)合國(guó)人膝關(guān)節(jié)形態(tài)大小的數(shù)據(jù)及形態(tài)學(xué)相關(guān)性,才能設(shè)計(jì)出更適合國(guó)人骨骼形態(tài)的人工關(guān)節(jié)假體。
[Abstract]:Objective: with the aging of the population in China and the degeneration of the knee joint in the elderly, the operation of artificial knee arthroplasty has become more and more common, so the success rate of the artificial knee replacement and the life of the artificial knee prosthesis have become the focus of attention. In an accurate operation, the key to the success of artificial knee arthroplasty is the precise osteotomy, the osteotomy angle, and the morphological matching degree of the prosthesis during the replacement of the knee joint. The three-dimensional reconstruction of the scanned images, and the reconstruction of the artificial knee replacement hand of the knee joint by the CT scan of the knee joint of the normal people are studied. The osteotomy, morphological measurement and statistical analysis of the proximal tibia and distal femur were performed to compare the differences between the morphological size of the knee joint of the Chinese people and the shape and size of the knee joints at home and abroad. At the same time, the size of the artificial knee joints of the Chinese people was designed to provide the morphological basis for guiding the production of human knee joint.
Methods: a CT scan was used to collect the CT scan images of the knee joint of 120 normal people, and the three-dimensional reconstruction software was used to reconstruct the three dimensional knee joint images of the Chinese people. The digital national knee joint model was established. The reconstruction of the 3D model of the knee joint was performed to simulate the replacement of the knee joint, and the 6mm of the knee was 7 degrees below the medial tibial plateau. The posterior tibial osteotomy of the knee joint was carried out and the distal femur osteotomy was maintained at the 6 degree angle of 9mm above the lowest point of the medial condyle of the distal femur. The anterior and posterior diameter of the osteotomy section (AP), the left and right diameter (ML) and other main related parameters were measured, and the results were analyzed and analyzed, and the shape ruler of some artificial joint prosthesis was used at home and abroad. A comparison was made to observe the gap between the shape of the prosthesis and the shape of the knee in the Chinese. According to the statistical data, the morphological design of the artificial knee joint was designed to provide a theoretical basis for the design of the artificial knee joints of the Chinese people.
Results: 120 sets of CT images of the knee joint of normal people were collected by CT scanning. The scanning range was above the 20cm of the joint line of the knee joint. The three-dimensional model of 120 normal Chinese knee joints was reconstructed below the joint line. The arthroplasty of the knee joint was simulated and the osteotomy of the proximal tibia and the distal femoral bone was carried out, and the shape of the osteotomy section was formed. The morphological measurements of the proximal tibia of the Chinese people: the diameter of the tibia (tML) was 75.9 + 2.9mm, the tibia diameter (tAP) was 52 + 2.2mm, and the correlation coefficient was 0.50; the left and right diameter of the tibia (tML) was 69.9 + 2.7mm, and the anterior and posterior diameter (tAP) was 46.5 + 2.1mm, and the correlation coefficient was 0.57; the total tibia diameter (tML) was 72.9 + 4.5mm, tibia and tibia. The anteroposterior diameter (tAP) was 49.6 + 3.5mm, and the correlation coefficient was 0.82..
The morphological measurements of 120 cases of the distal femur osteotomy section of the Chinese femur: the diameter of the femur (fML) was 74.9 + 2.9mm, the femur diameter (fAP) was 66.6 + 2.4mm, the correlation coefficient was 0.52, the femur diameter (fML) was 67.1 + 3.2mm, the femur diameter (fAP) was 61.6 + 2.9mm, and the correlation coefficient was 0.63, and the total femur diameter of the femur was (fML). 71.5 + 4.9mm, the anteroposterior diameter (fAP) of femur was 64.3 + 3.7mm, and the correlation coefficient was 0.80.
Conclusion: there is a strong correlation between tML and tAP in the proximal tibia of the Chinese knee joint, and the overall correlation is stronger than that of male and female individuals (male is 0.50, female is 0.57, and the total is 0.82). Compared with some artificial joint prostheses used in China, the shape and size of the prosthesis are found to be Scopio, PFC Sigma and national knee joint. The morphological matching degree is better. There is a certain gap between the other prosthesis size and the morphology of the Chinese knee joint. The fML and fAP of the distal femur have strong correlation, and the overall correlation is stronger than the male and female individual correlation (male is 0.52, the female is 0.63, and the total is 0.80). The results showed that only NexGen in the five kinds of artificial knee joint prosthesis had better matching degree of knee joint shape, and the rest of the artificial knee joint prosthesis had a certain gap with the state of the knee joint.
Because the overall correlation is stronger than the individual, the whole country should be taken as a whole in the design of the artificial joint, and the artificial joint prosthesis which is more suitable for the state of the human skeleton should be designed according to the data and the morphological correlation of the shape of the knee joint of the Chinese.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322;R687.4
[Abstract]:Objective: with the aging of the population in China and the degeneration of the knee joint in the elderly, the operation of artificial knee arthroplasty has become more and more common, so the success rate of the artificial knee replacement and the life of the artificial knee prosthesis have become the focus of attention. In an accurate operation, the key to the success of artificial knee arthroplasty is the precise osteotomy, the osteotomy angle, and the morphological matching degree of the prosthesis during the replacement of the knee joint. The three-dimensional reconstruction of the scanned images, and the reconstruction of the artificial knee replacement hand of the knee joint by the CT scan of the knee joint of the normal people are studied. The osteotomy, morphological measurement and statistical analysis of the proximal tibia and distal femur were performed to compare the differences between the morphological size of the knee joint of the Chinese people and the shape and size of the knee joints at home and abroad. At the same time, the size of the artificial knee joints of the Chinese people was designed to provide the morphological basis for guiding the production of human knee joint.
Methods: a CT scan was used to collect the CT scan images of the knee joint of 120 normal people, and the three-dimensional reconstruction software was used to reconstruct the three dimensional knee joint images of the Chinese people. The digital national knee joint model was established. The reconstruction of the 3D model of the knee joint was performed to simulate the replacement of the knee joint, and the 6mm of the knee was 7 degrees below the medial tibial plateau. The posterior tibial osteotomy of the knee joint was carried out and the distal femur osteotomy was maintained at the 6 degree angle of 9mm above the lowest point of the medial condyle of the distal femur. The anterior and posterior diameter of the osteotomy section (AP), the left and right diameter (ML) and other main related parameters were measured, and the results were analyzed and analyzed, and the shape ruler of some artificial joint prosthesis was used at home and abroad. A comparison was made to observe the gap between the shape of the prosthesis and the shape of the knee in the Chinese. According to the statistical data, the morphological design of the artificial knee joint was designed to provide a theoretical basis for the design of the artificial knee joints of the Chinese people.
Results: 120 sets of CT images of the knee joint of normal people were collected by CT scanning. The scanning range was above the 20cm of the joint line of the knee joint. The three-dimensional model of 120 normal Chinese knee joints was reconstructed below the joint line. The arthroplasty of the knee joint was simulated and the osteotomy of the proximal tibia and the distal femoral bone was carried out, and the shape of the osteotomy section was formed. The morphological measurements of the proximal tibia of the Chinese people: the diameter of the tibia (tML) was 75.9 + 2.9mm, the tibia diameter (tAP) was 52 + 2.2mm, and the correlation coefficient was 0.50; the left and right diameter of the tibia (tML) was 69.9 + 2.7mm, and the anterior and posterior diameter (tAP) was 46.5 + 2.1mm, and the correlation coefficient was 0.57; the total tibia diameter (tML) was 72.9 + 4.5mm, tibia and tibia. The anteroposterior diameter (tAP) was 49.6 + 3.5mm, and the correlation coefficient was 0.82..
The morphological measurements of 120 cases of the distal femur osteotomy section of the Chinese femur: the diameter of the femur (fML) was 74.9 + 2.9mm, the femur diameter (fAP) was 66.6 + 2.4mm, the correlation coefficient was 0.52, the femur diameter (fML) was 67.1 + 3.2mm, the femur diameter (fAP) was 61.6 + 2.9mm, and the correlation coefficient was 0.63, and the total femur diameter of the femur was (fML). 71.5 + 4.9mm, the anteroposterior diameter (fAP) of femur was 64.3 + 3.7mm, and the correlation coefficient was 0.80.
Conclusion: there is a strong correlation between tML and tAP in the proximal tibia of the Chinese knee joint, and the overall correlation is stronger than that of male and female individuals (male is 0.50, female is 0.57, and the total is 0.82). Compared with some artificial joint prostheses used in China, the shape and size of the prosthesis are found to be Scopio, PFC Sigma and national knee joint. The morphological matching degree is better. There is a certain gap between the other prosthesis size and the morphology of the Chinese knee joint. The fML and fAP of the distal femur have strong correlation, and the overall correlation is stronger than the male and female individual correlation (male is 0.52, the female is 0.63, and the total is 0.80). The results showed that only NexGen in the five kinds of artificial knee joint prosthesis had better matching degree of knee joint shape, and the rest of the artificial knee joint prosthesis had a certain gap with the state of the knee joint.
Because the overall correlation is stronger than the individual, the whole country should be taken as a whole in the design of the artificial joint, and the artificial joint prosthesis which is more suitable for the state of the human skeleton should be designed according to the data and the morphological correlation of the shape of the knee joint of the Chinese.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322;R687.4
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