股骨遠(yuǎn)端的三維測(cè)量與性別差異化股骨假體的改進(jìn)分析
發(fā)布時(shí)間：2018-11-26 18:52
【摘要】： 第一部分股骨遠(yuǎn)端解剖形態(tài)性別差異與假體形態(tài)設(shè)計(jì)的關(guān)系 目的通過(guò)三維螺旋CT重建正常人膝關(guān)節(jié),測(cè)量股骨遠(yuǎn)端相關(guān)解剖參數(shù),探討男女性股骨遠(yuǎn)端的解剖特點(diǎn)對(duì)于關(guān)節(jié)表面假體形態(tài)的不同要求。 方法80側(cè)正常成人膝關(guān)節(jié),男性、女性各40側(cè),年齡18～72歲,行三維螺旋CT掃描,在GE Advantage workstation工作站上進(jìn)行0.625 mm層厚重建,在Geomagic Studio三維圖像處理系統(tǒng)上模擬截骨,測(cè)量股骨經(jīng)上髁軸線寬度、內(nèi)外側(cè)髁高度、髁間高度及內(nèi)外側(cè)滑車前突距離,以及相關(guān)截骨面參數(shù),比較各測(cè)量值性別間的差異。 結(jié)果男女性髁間高度、經(jīng)上髁軸線寬度、外側(cè)髁高度及內(nèi)側(cè)髁高度均有顯著性差異(P＜0.001),男性各值均大于女性。股骨遠(yuǎn)端橫徑與縱徑的比值亦為男性大于女性(P＜0.001),男性股骨內(nèi)、外側(cè)滑車前突距離均大于女性,均值差分別為1.1 mm和0.7 mm,均有顯著性差異(P＜0.001)。 結(jié)論男女性之間股骨髁形態(tài)存在一定差別,股骨遠(yuǎn)端關(guān)節(jié)面假體形態(tài)的設(shè)計(jì)應(yīng)該性別差異化,使假體與截骨面更好的吻合。以提高全膝關(guān)節(jié)置換的手術(shù)效果。 第二部分三維螺旋CT重建股骨遠(yuǎn)端旋轉(zhuǎn)力線的測(cè)量 目的通過(guò)三維螺旋CT重建正常成人膝關(guān)節(jié),測(cè)量股骨遠(yuǎn)端旋轉(zhuǎn)力線,為全膝關(guān)節(jié)置換術(shù)股骨假體旋轉(zhuǎn)力線的定位提供理論依據(jù)。 方法80側(cè)正常成人膝關(guān)節(jié),男性、女性各40側(cè),年齡18～72歲,行三維螺旋CT掃描,在GE Advantage workstation工作站上進(jìn)行0.625 mm層厚重建,測(cè)量股骨外科上髁軸線與股骨后髁軸線之間的夾角(股骨后髁角,PCA)及前后軸線的垂線與股骨后髁軸線的央角(APA),比較男女性股骨旋轉(zhuǎn)力線的差異。 結(jié)果PCA:男性3.21°±1.35°(1.15°～5.92°),女性3.60°+1.40°(0.84°～5.76°);APA:男性3.17°±1.62°(0.87°～5.73°),女性3.66°±1.58°(1.34°±6.05°)。PCA與APA的差異無(wú)統(tǒng)計(jì)學(xué)意義,但性別間PCA及APA差異均有統(tǒng)計(jì)學(xué)意義,同時(shí)PCA和APA均有較大的個(gè)體差異。 結(jié)論男女性及不同個(gè)體之間股骨后髁角值存在一定差別,統(tǒng)一參照股骨后髁軸截骨將導(dǎo)致假體安放不準(zhǔn)確,應(yīng)采用多種定位方法確定股骨側(cè)截骨,術(shù)前三維螺旋CT掃描重建股骨遠(yuǎn)端,測(cè)量后髁角,有利于術(shù)中重建準(zhǔn)確的旋轉(zhuǎn)力線。
[Abstract]:The first part the relationship between the sexual difference of anatomical morphology of distal femur and the shape design of prosthesis objective to reconstruct the normal knee joint by three-dimensional spiral CT and to measure the anatomical parameters of the distal femur. To explore the different requirements of the anatomical features of the distal femur of men and women for the morphology of the joint surface prosthesis. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning. The thickness of 0.625 mm layer was reconstructed on GE Advantage workstation. Osteotomy was simulated on Geomagic Studio 3D image processing system. The width of transepicondylar axis, the height of internal and external condyle, the height of intercondylar, the distance of anterior protrusion of trochlear and the parameters of osteotomy were measured. Results there were significant differences in the height of intercondylar between male and female, the width of axis of epicondyle, the height of lateral condyle and the height of medial condyle (P < 0.001). The ratio of transverse diameter to longitudinal diameter of distal femur was also larger in males than in females (P < 0.001). The distance between medial and lateral trochlear protrusions in males was larger than that in females, and the mean differences were 1. 1 mm and 0. 7 mm, respectively. There was significant difference between the two groups (P < 0.001). Conclusion there are some differences in the shape of femoral condyle between men and women. The design of the prosthesis of the distal femoral articular surface should be gender differentiated, so that the prosthesis and osteotomy surface can be better matched. In order to improve the operation effect of total knee arthroplasty. The second part the measurement of rotational force line of distal femur by three-dimensional spiral CT objective to reconstruct the normal knee joint by three-dimensional spiral CT and measure the rotational force line of distal femur. To provide theoretical basis for the positioning of rotation force line of femoral prosthesis in total knee arthroplasty. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning, and 0.625 mm thickness reconstruction was performed on GE Advantage workstation. The angle between the supracondylar axis and the posterior femoral condylar axis (, PCA) of the posterior femoral condyle and the central angle of the vertical axis of the posterior femoral condyle and the central angle of the posterior femoral condyle) were measured to compare the male and female femoral rotation force lines. Results PCA: was 3.21 擄鹵1.35 擄(1.15 擄~ 5.92 擄) in male and 3.60 擄1.40 擄(0.84 擄~ 5.76 擄) in female. There was no significant difference between APA: male 3.17 擄鹵1.62 擄(0.87 擄~ 5.73 擄), female 3.66 擄鹵1.58 擄(1.34 擄鹵6.05 擄). PCA) and APA, but there were significant differences in PCA and APA between male and female. At the same time, PCA and APA have great individual differences. Conclusion the angle of posterior femoral condyle is different between men and women and different individuals. Reference to osteotomy of posterior femoral condyle axis will lead to inaccurate placement of the prosthesis. Multiple localization methods should be used to determine femoral osteotomy. The reconstruction of distal femur and posterior condyle angle by three dimensional spiral CT scan before operation is beneficial to the reconstruction of accurate rotation force line.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R318.1;R322
本文編號(hào)：2359337
[Abstract]:The first part the relationship between the sexual difference of anatomical morphology of distal femur and the shape design of prosthesis objective to reconstruct the normal knee joint by three-dimensional spiral CT and to measure the anatomical parameters of the distal femur. To explore the different requirements of the anatomical features of the distal femur of men and women for the morphology of the joint surface prosthesis. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning. The thickness of 0.625 mm layer was reconstructed on GE Advantage workstation. Osteotomy was simulated on Geomagic Studio 3D image processing system. The width of transepicondylar axis, the height of internal and external condyle, the height of intercondylar, the distance of anterior protrusion of trochlear and the parameters of osteotomy were measured. Results there were significant differences in the height of intercondylar between male and female, the width of axis of epicondyle, the height of lateral condyle and the height of medial condyle (P < 0.001). The ratio of transverse diameter to longitudinal diameter of distal femur was also larger in males than in females (P < 0.001). The distance between medial and lateral trochlear protrusions in males was larger than that in females, and the mean differences were 1. 1 mm and 0. 7 mm, respectively. There was significant difference between the two groups (P < 0.001). Conclusion there are some differences in the shape of femoral condyle between men and women. The design of the prosthesis of the distal femoral articular surface should be gender differentiated, so that the prosthesis and osteotomy surface can be better matched. In order to improve the operation effect of total knee arthroplasty. The second part the measurement of rotational force line of distal femur by three-dimensional spiral CT objective to reconstruct the normal knee joint by three-dimensional spiral CT and measure the rotational force line of distal femur. To provide theoretical basis for the positioning of rotation force line of femoral prosthesis in total knee arthroplasty. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning, and 0.625 mm thickness reconstruction was performed on GE Advantage workstation. The angle between the supracondylar axis and the posterior femoral condylar axis (, PCA) of the posterior femoral condyle and the central angle of the vertical axis of the posterior femoral condyle and the central angle of the posterior femoral condyle) were measured to compare the male and female femoral rotation force lines. Results PCA: was 3.21 擄鹵1.35 擄(1.15 擄~ 5.92 擄) in male and 3.60 擄1.40 擄(0.84 擄~ 5.76 擄) in female. There was no significant difference between APA: male 3.17 擄鹵1.62 擄(0.87 擄~ 5.73 擄), female 3.66 擄鹵1.58 擄(1.34 擄鹵6.05 擄). PCA) and APA, but there were significant differences in PCA and APA between male and female. At the same time, PCA and APA have great individual differences. Conclusion the angle of posterior femoral condyle is different between men and women and different individuals. Reference to osteotomy of posterior femoral condyle axis will lead to inaccurate placement of the prosthesis. Multiple localization methods should be used to determine femoral osteotomy. The reconstruction of distal femur and posterior condyle angle by three dimensional spiral CT scan before operation is beneficial to the reconstruction of accurate rotation force line.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R318.1;R322
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2 尚延春;陳海龍;王戰(zhàn)朝;;引起全膝表面假體置換手術(shù)下肢力線不好的幾個(gè)原因[J];中醫(yī)正骨;2007年08期
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