本文選題：多排螺旋CT + 髖臼��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:通過多排螺旋CT(Multi-slice spiral computedtomography,MSCT)三維重建骨盆,測(cè)得骨盆在不同傾斜程度下髖臼前傾角和外展角數(shù)值,運(yùn)用統(tǒng)計(jì)學(xué)軟件計(jì)算前傾角和外展角的平均值和標(biāo)準(zhǔn)差,并繪制出其與骨盆傾度的相關(guān)性變化曲線,從中找到規(guī)律,指導(dǎo)非生理狀態(tài)下全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)個(gè)體化置入髖臼假體的放置角度。方法:本研究選擇50位患者(即100個(gè)髖臼)為研究對(duì)象進(jìn)螺旋CT掃描,利用容積再現(xiàn)(volume rendering technique即VRT)技術(shù)把骨盆重建為立體圖像,進(jìn)而對(duì)骨盆進(jìn)行不同程度的前傾(以10°為間隔,從10°前傾到90°),利用多平面重組(multi-planar reconstructions即MPR)分別重建出冠狀位及水平位圖像,進(jìn)而分別測(cè)得兩側(cè)外展角、計(jì)算兩側(cè)前傾角。前傾角的測(cè)量方法,每個(gè)髖臼都要測(cè)得上、中、下三個(gè)平面的前傾角,以髖臼的最大層面為中間層面,上層面位于中間層面的上一層,下層面則位于中間層面的下一層,間隔為5mm。依據(jù)前傾角的定義,在水平位上髖臼前后緣點(diǎn)連線與雙側(cè)髖臼后緣連線的夾角的余角作為前傾角,并對(duì)上、中、下三個(gè)層面進(jìn)行測(cè)量和計(jì)算,所得平均值即為前傾角。外展角也要測(cè)前、中、后三個(gè)平面,以髖臼的最大層面為中間層面,前層面位于中間層面的前一層,后層面則位于中間層面的后一層,間隔為5mm。根據(jù)外展角的定義,在冠狀位上髖臼上下緣連線和雙側(cè)髖臼下緣連線的夾角為外展角,并對(duì)前、中、后三個(gè)層面進(jìn)行測(cè)量和計(jì)算,所得平均值即為外展角。選垂直于地面的面為基準(zhǔn)平面,把骨盆前平面(兩側(cè)髂前上棘與恥骨聯(lián)合前緣所構(gòu)成的面)定為參照平面,二者之間的角度即為骨盆前傾角度。為模擬病理狀態(tài),則改變骨盆傾度,把骨盆分別進(jìn)行10-90°的傾斜(以10°為間隔),分別測(cè)出骨盆傾度在10-90°下前傾角和外展角,采用統(tǒng)計(jì)學(xué)軟件計(jì)算平均值和標(biāo)準(zhǔn)差,繪制出非生理狀態(tài)下髖臼前傾角和外展角隨骨盆傾度改變而發(fā)生變化的相關(guān)性變化曲線,從中找到規(guī)律,為臨床THA手術(shù)置入髖臼假體放置角度提供相關(guān)的理論依據(jù)。結(jié)果:對(duì)測(cè)得的數(shù)據(jù)分成男性、女性和混合三組做統(tǒng)計(jì)學(xué)處理,求出各組平均值和標(biāo)準(zhǔn)差,并進(jìn)行顯著性檢驗(yàn),當(dāng)P0.05時(shí),說明差異有統(tǒng)計(jì)學(xué)意義。以骨盆傾度為橫坐標(biāo),髖臼前傾角和外展角為縱坐標(biāo),繪制出骨盆傾度與髖臼兩角的相關(guān)變化曲線。MSCT法檢測(cè)髖臼前傾角結(jié)果如下:當(dāng)骨盆傾度從10°逐漸增加至90°時(shí),前傾角隨之減小,變化曲線呈線性相關(guān),擬合后得到的回歸方程為y=-0.4582x+40.714,r=0.996,線性良好。根據(jù)方程計(jì)算可知,當(dāng)骨盆傾度達(dá)到83°時(shí),前傾角可達(dá)0。MSCT法檢測(cè)髖臼外展角結(jié)果如下:當(dāng)骨盆傾度從10°逐漸增至90°時(shí),外展角的變化曲線呈拋物線。當(dāng)骨盆傾度為60°-70°之間時(shí),外展角最大,處于42°-48°之間,說明此狀態(tài)下的髖臼對(duì)股骨頭覆蓋最好,關(guān)節(jié)的穩(wěn)定性也最佳。另外本研究還分析了性別對(duì)髖臼前傾角和外展角的影響,結(jié)果表明在相同條件下,所得的不同性別之間的前傾角和外展角并無顯著性差異(P0.05)。結(jié)論:1.髖臼的前傾角和外展角隨著骨盆傾度的變化而發(fā)生改變。髖臼的前傾角與骨盆傾度呈線性相關(guān)。外展角的變化曲線呈拋物線。骨盆的傾斜程度敏感地影響髖臼的前傾角和外展角的變化。髖臼兩角隨骨盆傾度動(dòng)態(tài)變化的規(guī)律,可以為臨床THA手術(shù)中髖臼假體放置角度提供理論依據(jù)。2.根據(jù)比較不同性別髖臼前傾角和外展角,結(jié)果發(fā)現(xiàn)不同性別之間的髖臼前傾角、外展角沒有顯著性差異。這說明性別因素對(duì)髖臼的前傾角和外展角的影響不大。
[Abstract]:Objective: by multi-slice spiral CT (Multi-slice spiral computedtomography, MSCT) three dimensional reconstruction of pelvis, pelvic tilt measured in different degrees of acetabular anteversion and abduction angle of numerical calculation, abduction angle and anteversion angle of the average value and standard deviation of the use of statistical software, and draw out the changes associated with pelvic inclination of the curve, find from the law, to guide the non physiological state of total hip arthroplasty (total hip, arthroplasty, THA) position of the individual placement of the acetabular component. Methods: This study selected 50 patients (100 hips) in spiral CT scan as the research object, using volume rendering (volume rendering technique VRT) technology to the pelvis for the reconstruction of stereo images, and different degrees of anteversion of the pelvis (at 10 degrees intervals from 10 degrees to 90 degrees forward), multi planar reconstruction (multi-planar reconstructions MPR) were reconstructed Coronal and horizontal images, which were measured on both sides of the abduction angle and anteversion angle measurement method. The calculation on both sides of the acetabular anteversion, each must be measured, and the three plane angle, to the maximum level of acetabular for the middle layer, the upper surface is located in the middle level of the lower layer. The surface is located in the middle level of the next layer interval for the definition of 5mm. according to the anteversion angle, angle margin line and bilateral acetabulum attachment in the horizontal position of the acetabular anteversion angle as before and after, and, in three aspects of measurement and calculation, the average value is the anteversion. To measure the abduction angle before, after the three plane, with the maximum level of acetabular for middle level, before the level is located in the middle level before, after the level is located in the middle level after an interval of 5mm. layer, according to the definition of the abduction angle in coronal position, suprainferior margin. The angle between the line and the lower edge of the connection for the bilateral acetabular abduction angle, and before, after three levels were measured and calculated, the average value is selected. The abduction angle perpendicular to the ground surface as the reference plane, the anterior pelvic plane (on both sides of the anterior superior iliac spine and the pubic symphysis of the front surface) as a reference plane, the two is the angle between the pelvis forward angle. In order to simulate the pathological state, change the inclination of pelvis, pelvic tilt were 10-90 degrees (10 degrees apart), pelvic inclination were measured at 10-90 degrees under the abduction angle and anteversion angle, calculate the average value and standard deviation of the statistical software, draw the correlation curve of the non physiological state of acetabular abduction angle and anteversion angle with the pelvis inclination change, find the law, provide relevant theoretical basis for the clinical operation of THA implanted acetabular prosthesis placement angle. Results: the measured The data are divided into three groups of male, female and mixed groups were calculated statistically, the mean and standard deviation, and significant test shows that when P0.05, the difference was statistically significant. The pelvic inclination as abscissa, acetabular abduction angle and anteversion angle as the ordinate, draw the relevant changes in pelvic and acetabular inclination the detection method of.MSCT curve of Liangjiao acetabular anteversion results are as follows: when the pelvic inclination from 10 degrees to 90 degrees increased gradually when the anteversion angle decreases, a linear correlation curve fitting, the regression equation obtained after y=-0.4582x+40.714, r=0.996, linear calculation. According to the equation, when the inclination of 83 degrees of pelvis, detection the acetabular abduction angle up to 0.MSCT results are as follows: when the pelvic inclination angle from 10 degrees to 90 degrees gradually when the curve of the abduction angle of the parabola. When the pelvis inclination is between 60 DEG -70 DEG, abduction angle in the 4 largest. Between 2 -48 degrees, the state of the acetabulum of the femoral head covering best joint stability is also the best. This study also analyzed the impact of gender on acetabular anteversion and abduction angle. The results show that under the same conditions, between different gender the abduction angle and anteversion angle had no difference (P0.05). Conclusion: 1. acetabular abduction angle and anteversion angle changes with the change of pelvic inclination. Acetabular anteversion and inclination of pelvis showed a linear correlation curve. The abduction angle was parabola. Changes in tilt of the pelvis is sensitive to the effects of acetabular abduction angle and anteversion angle of the acetabular angles change with pelvic inclination. Dynamic rules, can provide a theoretical basis of.2. according to the comparison of different gender of acetabular abduction angle and anteversion angle of acetabulum prosthesis in clinical THA surgical placement of the acetabular anteversion results between different sexes, outside There is no significant difference in the angle of the abduction. This shows that the gender factors have little effect on the anteversion angle and abduction angle of the acetabulum.

【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
【分類號(hào)】：R687.4

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