本文選題：髕骨穩(wěn)定 + 脛骨結(jié)節(jié)-股骨滑車溝距離��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:利用CT圖像疊加融合技術(shù)對膝關(guān)節(jié)CT圖像進(jìn)行分析,測量設(shè)定的股骨滑車不同參考層面的脛骨結(jié)節(jié)-股骨滑車溝距離(TT-TG),分析選取股骨滑車溝不同位置為基點(diǎn)對TT-TG測量的影響。并評價(jià)在每個(gè)參考層面以股骨滑車溝最深點(diǎn)及股骨髁間窩最深點(diǎn)作為股骨端垂線的兩種測量方法獲得TT-TG及脛骨結(jié)節(jié)-股骨髁間窩距離(TT-PD)。測量不同參考層面的股骨滑車溝角角度,髕韌帶長度與髕骨長度的比值(PLL/PL)以及髕內(nèi)、外側(cè)支持帶長度,探討這些參數(shù)與TT-TG值之間的相關(guān)性。對象與方法:本研究分為兩部分,第一部分為TT-TG測量方法的探討,納入在我院行膝關(guān)節(jié)CT檢查的患者共60例,其中男42例,女18例,左側(cè)膝關(guān)節(jié)31例,右側(cè)膝關(guān)節(jié)29例,年齡18至40歲,將CT掃描獲得的薄層圖像數(shù)據(jù)傳入工作站進(jìn)行后處理重組及測量。將設(shè)定的股骨滑車溝5個(gè)等分參考層面與所選定的脛骨結(jié)節(jié)層面圖像疊加,測量TT-TG值并進(jìn)行方差分析,并在這5個(gè)疊加圖像上測量TT-PD值并進(jìn)行方差分析;分別分析5個(gè)參考層面測量的TT-TG值與TT-PD值的相關(guān)性;比較左、右側(cè)膝關(guān)節(jié)TT-TG值的差異以及男、女性膝關(guān)節(jié)TT-TG值的差異。第二部分為TT-TG與其它髕骨穩(wěn)定參數(shù)的相關(guān)性研究,對上述納入的病例,在5個(gè)等分參考層面上測量滑車溝角角度,在重組正中矢狀位圖像上測量髕骨長度、髕韌帶長度并依據(jù)Insall-Salvati比率法計(jì)算其比值,在選定的軸位圖像上測量髕內(nèi)、外側(cè)支持帶長度。分析在5個(gè)參考層面測得5組股骨滑車溝角角度間的差異;分別對滑車溝角角度、髕韌帶長度與髕骨長度的比值、髕內(nèi)、外側(cè)支持帶長度與測量的TT-TG距離進(jìn)行相關(guān)性分析。結(jié)果:選取股骨滑車溝不同位置為基點(diǎn)所測得的TT-TG值差異無統(tǒng)計(jì)學(xué)意義(P0.05),相應(yīng)層面所測得的TT-PD值差異無統(tǒng)計(jì)學(xué)意義(P0.05);但比較這兩種方法測量的TT-TG值與TT-PD值差異有統(tǒng)計(jì)學(xué)意義(P0.05),TT-PD數(shù)值偏大,且TT-TG值與TT-PD值兩組數(shù)據(jù)間呈明顯正性相關(guān)關(guān)系。左、右兩側(cè)膝關(guān)節(jié)的TT-TG值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。男、女不同性別的膝關(guān)節(jié)TT-TG值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。選擇股骨滑車面不同位置作為參考層面,所測得的股骨滑車溝角差異有統(tǒng)計(jì)學(xué)意義(P0.05)。股骨滑車溝角,髕韌帶長度與髕骨長度的比值,髕內(nèi)、外側(cè)支持帶長度均與TT-TG值之間沒有相關(guān)性。結(jié)論:在股骨滑車溝任意一點(diǎn)測量TT-TG值均可作為評價(jià)參數(shù)。兩種不同方法測得的兩種距離TT-TG和TT-PD數(shù)值有差異,以后者股骨髁間窩最深點(diǎn)選取股骨端垂線的測量方法數(shù)值偏大。在進(jìn)行左、右側(cè)別及男、女性別的TT-TG值比較時(shí),發(fā)現(xiàn)左側(cè)膝關(guān)節(jié)TT-TG值要低于右側(cè),男性膝關(guān)節(jié)TT-TG值均比女性偏大。TT-TG值能夠反映髕骨的穩(wěn)定性,股骨滑車溝角,髕韌帶長度與髕骨長度的比值,髕內(nèi)、外側(cè)支持帶長度均與TT-TG值未見明顯相關(guān)性,但是滑車溝角,髕韌帶長度與髕骨長度的比值是髕骨穩(wěn)定的重要因素,髕內(nèi)、外側(cè)支持帶為固定髕骨的因素,所以評價(jià)髕骨穩(wěn)定性時(shí)需要多參數(shù)測量。
[Abstract]:Objective: to analyze the CT image of the knee joint by CT image superposition fusion technique, to measure the tibial tubercle of the different reference layers of the trochlea of the femur and the distance of the trochlear trench (TT-TG), and to analyze the influence of the different position of the trochlear trench of the femur on the measurement of the TT-TG, and to evaluate the deepest point and the femoral trochlear trench at the reference level. TT-TG and tibial tubercle intercondylar fossa distance (TT-PD) were obtained by two methods of measuring the deepest point of the intercondylar fossa. The angle of the trochlear groove angle, the ratio of the length of the patellar ligament to the patellar length (PLL/PL) and the length of the patellar and lateral retinaculum were measured at different reference levels, and the correlation between these parameters and the value of the TT-TG was discussed. The study was divided into two parts. The first part was divided into two parts. The first part was the study of the method of TT-TG measurement. There were 60 cases of knee joint CT examination in our hospital. There were 42 men, 18 women, 31 left knee joints, 29 right knee joints, 18 to 40 years old, and the CT scan obtained thin layer image data to the workstation for post-processing and reprocessing. And measurements. The TT-TG values of the 5 equal sections of the trochlea trench and the selected tibial tubercle image were superimposed, and the values were measured and the variance analysis was carried out. The TT-PD values were measured on the 5 superimposed images and the variance analysis was carried out. The correlation between the TT-TG value of the 5 reference layers and the TT-PD value were analyzed, and the left and right knee joints were compared. The difference in TT-TG values and the difference in the TT-TG value of the knee joint in men and women. The second part is the correlation between TT-TG and other patellar stability parameters. The above included cases are measured at the angle of the trochlear angle at the 5 level of reference level and the patellar length is measured on the reconstructed median sagittal image, the length of the patellar ligament is based on the Insall-Salvati ratio. The ratio was calculated by the rate method. The length of the medial patellar and lateral support band was measured on the selected axial image. The differences between the angle of the 5 groups of trochlear trench angles were measured at 5 reference levels, and the ratio of the angle of the trochlear angle, the length of patellar ligament to the length of the patella, the length of the lateral patellar support band and the distance of the measured TT-TG were analyzed. Results: there was no statistically significant difference in the TT-TG value measured in the different position of the trochlear trench of the trochlear groove (P0.05). There was no significant difference in the TT-PD value measured at the corresponding level (P0.05), but the difference between the TT-TG value measured by the two methods and the TT-PD value was statistically significant (P0.05), the TT-PD value was larger, and the TT-TG value and the TT-PD value were two groups. There was no significant difference in TT-TG value between the left and right sides of the knee (P0.05). There was no statistically significant difference in the TT-TG value of the knee joint in male and female sex (P0.05). The difference of the different position of the trochlear surface of the femur was statistically significant (P0.05). The femoral trochlear groove was statistically significant (P0.05). Angle, the ratio of the length of patellar ligament to the length of the patella, there is no correlation between the length of the medial patellar and the lateral support band and the TT-TG value. Conclusion: the measurement of the TT-TG value at any point in the trochlear groove of the femur can be used as an evaluation parameter. The values of the two distances measured by the two different methods are different from the values of TT-TG and TT-PD, and the femur is selected at the deepest point in the intercondylar fossa of the femur. The TT-TG value of the left knee joint was lower than that of the right, and the TT-TG value of the male knee joint was higher than that of the female, and the TT-TG value of the male knee joint was better than the female.TT-TG value to reflect the stability of the patella, the angle of the trochlear trench, the ratio of the patellar ligament length to the patellar length, the internal and lateral branches of the patellar tendon, and the ratio of the patellar length to the patellar length. There is no significant correlation between the length of the holding band and the TT-TG value, but the ratio of the length of patellar ligament to the length of patellar ligament is an important factor for patellar stability. In the patellar, the lateral support band is the factor of patellar fixation, so it is necessary to measure the stability of the patella when evaluating the patellar stability.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R684;R816.8

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