本文選題：股骨髓腔測(cè)量 + 股骨近端參數(shù)　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:明確股骨近端髓腔形態(tài)學(xué)參數(shù)受到哪些因素影響,明確股骨頸保留型全髖關(guān)節(jié)置換術(shù)中股骨假體型號(hào)選擇的規(guī)律性,為股骨頸保留型全髖關(guān)節(jié)置換提供術(shù)前假體型號(hào)準(zhǔn)備,減少手術(shù)時(shí)間、提高假體固定的精確度、增加手術(shù)的安全性。方法:選取2015年8月至2016年8月河北醫(yī)科大學(xué)第三醫(yī)院骨病科完成的應(yīng)用CFP假體進(jìn)行的全髖關(guān)節(jié)置換術(shù)患者為研究對(duì)象,共測(cè)量CFP假體全髖關(guān)節(jié)置換術(shù)后157例患者200髖;其中男性99人123髖,年齡48.2±11.9歲,最大76歲,最小22歲;女性58人77髖,年齡53.3±12歲,其中最大74歲,最小28歲;左側(cè)87髖,右側(cè)113髖。應(yīng)用PACS系統(tǒng)自帶的測(cè)量軟件進(jìn)行股骨近端相關(guān)參數(shù)的測(cè)量,測(cè)量指標(biāo)包括小轉(zhuǎn)子中點(diǎn)水平股骨髓腔內(nèi)徑(T0)、小轉(zhuǎn)子中點(diǎn)水平上20mm股骨髓腔內(nèi)徑(T+20)、小轉(zhuǎn)子中點(diǎn)水平下20mm股骨髓腔內(nèi)徑(T-20)、CFP假體末端股骨髓腔內(nèi)徑(T端)、股骨峽部髓腔內(nèi)徑(T峽內(nèi))、股骨峽部外徑(T峽外)、股骨頭偏心距(offset)、殘留股骨頸高度(H殘頸)、峽部位置(H峽高),計(jì)算股骨近端髓腔閃爍指數(shù)(CFI)、股骨干骺端髓腔開大指數(shù)(MCFI)、股骨遠(yuǎn)端髓腔開大指數(shù)(DCFI)、皮質(zhì)指數(shù)(CI)、皮質(zhì)厚度、柄端距峽部的距離(H峽余)等參數(shù);同時(shí)記錄患者性別、年齡、身高、體重、體重指數(shù)(BMI)。通過統(tǒng)計(jì)學(xué)處理:各參數(shù)用均數(shù)±標(biāo)準(zhǔn)差表示,參數(shù)間差別比較用t檢驗(yàn)或方差分析、參數(shù)間相關(guān)性應(yīng)用相關(guān)分析。結(jié)果:1測(cè)得T+20為43.81±4.28mm,T-20為26.48±3.42mm,T0為18.78±2.63mm,T端為12.62±2.04mm,H柄高為64.14±10.16mm,T峽內(nèi)為11.06±2.09mm,T峽外為27.08±2.79mm,H峽高為105.99±11.98mm,H峽余為41.85±12.55mm,H殘頸為18.38±3.67mm,offset為42.50±6.19mm,CFI為4.18±0.82,MCFI為2.42±0.31,DCFI為1.73±0.24,CI為0.57±0.08,皮質(zhì)厚度為7.51±1.39。2本組與國(guó)內(nèi)其他研究組測(cè)量值相比較無(wú)統(tǒng)計(jì)學(xué)意義,與Noble組及Massin組比較T+20、T0、T-20、T峽內(nèi)、峽部位置均減小,有統(tǒng)計(jì)學(xué)意義。3左右側(cè)股骨近端相關(guān)參數(shù)比較無(wú)顯著性差異;左右側(cè)假體型號(hào)選擇亦無(wú)顯著差異。4男女性別間T+20、T0、T-20、T峽內(nèi)差異有統(tǒng)計(jì)學(xué)意義,男性股骨近端髓腔較女性大;術(shù)中實(shí)際男女性使用假體型號(hào),男性患者以M號(hào)為主,女性患者以S號(hào)為主。5身高與股骨近端髓腔參數(shù)有較強(qiáng)正相關(guān)性,與股骨假體型號(hào)呈正相關(guān)。體重及體重指數(shù)與峽部外徑、皮質(zhì)厚度存在正相關(guān)。6 DDH組T+20、T0、T-20、T峽內(nèi)、峽部位置較其他組為小,差異有統(tǒng)計(jì)學(xué)意義,而其他疾病組間差異無(wú)統(tǒng)計(jì)學(xué)意義。DDH患者臨床手術(shù)過程中使用股骨柄型號(hào)以XS、S號(hào)為主。7 T0、T-20在不同股骨柄型號(hào)間比較差異有統(tǒng)計(jì)學(xué)意義,T+20無(wú)統(tǒng)計(jì)學(xué)意義;CFP股骨柄型號(hào)選擇與T0、T-20呈較強(qiáng)的正相關(guān)性,與T+20無(wú)明顯相關(guān)性。8峽部髓腔內(nèi)徑與CFP柄端部髓腔內(nèi)徑呈強(qiáng)的正相關(guān),與股骨柄型號(hào)選擇存在強(qiáng)正相關(guān)。9 CFI、MCFI、Noble分型與股骨柄選擇存在強(qiáng)相關(guān)性,DCFI與股骨柄型號(hào)選擇存在弱相關(guān)。結(jié)論:1國(guó)人股骨近端髓腔徑線較歐美人小,倒香檳瓶型髓腔較歐美人比例大;術(shù)中使用CFP假體型號(hào)集中于XS-M號(hào),不呈正態(tài)分布而偏向小號(hào)假體,說明基于西方人較大骨骼設(shè)計(jì)的CFP假體相對(duì)于國(guó)人偏大。2身高與股骨近端髓腔參數(shù)及CFP股骨柄型號(hào)呈正相關(guān)性,隨著身高增大,股骨近端髓腔徑線相應(yīng)變大,使用CFP假體型號(hào)也增大。3不同疾病組間比較,髖關(guān)節(jié)發(fā)育不良患者股骨近端髓腔徑線偏小,手術(shù)時(shí)需要準(zhǔn)備較小型號(hào)假體,或準(zhǔn)備遠(yuǎn)端較細(xì)的先髖假體。4 CFP假體型號(hào)與小轉(zhuǎn)子中點(diǎn)、小轉(zhuǎn)子中點(diǎn)水平下20mm、峽部髓腔內(nèi)徑關(guān)系密切,以上三點(diǎn)處髓腔寬大患者需要使用較大型號(hào)CFP假體。5 CFI、MCFI能很好的反應(yīng)股骨近端及大粗隆處髓腔形態(tài),與CFP假體型號(hào)高度相關(guān),CFI、MCFI越小使用CFP假體型號(hào)越大。
[Abstract]:Objective: to determine the influence of the morphological parameters of the proximal femoral medullary cavity, to clarify the regularity of the selection of femoral prosthesis in the femoral neck reserved total hip replacement, to provide the preoperation model preparation for the femoral neck reserved total hip replacement, to reduce the operation time, to improve the accuracy of the prosthesis fixation, and to increase the safety of the operation. Methods: the total hip arthroplasty performed by the CFP prosthesis of the orthopedics department of the Third Hospital of Hebei Medical University from August 2015 to August 2016 was studied. 157 patients with 200 hips after total hip replacement of CFP prosthesis were measured. Among them, 99 were 123 hips, 48.2 + 11.9 years old, the maximum 76, and the smallest 22 years old; and 58 women of 58 77. The hip, age 53.3 + 12 years old, the maximum 74 years old, the smallest 28 years old, the left 87 hip and the right 113 hip. The measurement of the proximal femur related parameters with the PACS system was used to measure the femoral medullary diameter of the middle point of the small rotors (T0), the middle point level of the 20mm femur cavity (T+20) at the middle point of the small trochanter, and the middle point level of the small rotors at the 20mm level. The intramedullary diameter of the femoral medulla (T-20), the internal diameter of the femoral medullary cavity at the end of the CFP prosthesis (T end), the internal diameter of the femoral medullary cavity in the femoral isthmus (T isthmus), the external diameter of the femoral isthmus (outside the isthmus of T), the femoral head eccentricity (offset), the residual neck height of the femur (H remnant neck), the position of the isthmus (H gorge), the calculation of the proximal femur medullary scintillation index (CFI), the large index of the femoral metaphyseal marrow cavity (MCFI), femur far (MCFI), and femur far away The parameters of large index (DCFI), cortical index (CI), cortical thickness, distance from the stem to the isthmus (H gorge), and the sex, age, height, weight, and body mass index (BMI) of the patients were recorded at the same time. By statistical treatment, the parameters were shown by mean number + standard difference table, and the difference of parameters was compared with t test or variance analysis and correlation application between parameters. Results: 1 T+20 is 43.81 + 4.28mm, T-20 is 26.48 + 3.42mm, T0 is 18.78 + 2.63mm, T end is 12.62 + 2.04mm, H handle is 64.14 + 10.16mm, T isthmus is 11.06 +, 27.08 +, 105.99 +, 41.85 + and 41.85 +. 2.42 + 0.31, DCFI 1.73 + 0.24, CI 0.57 + 0.08, cortical thickness 7.51 + 1.39.2 compared with other domestic research group, no statistical significance, T+20, T0, T-20, T isthmus, T+20, T0, T-20, and T isthmus, there were statistically significant differences in the proximal left femur related parameters of.3, and there was no significant difference between the left and right proximal femur. There was no significant difference in the selection of the side prosthesis of.4, T+20, T0, T-20, and T in the isthmus of the male. The male femur proximal medullary cavity was larger than that of the female; the male patients were mainly the male patients in the operation, the male patients were mainly M, and the female patients with S number.5 were strongly correlated with the proximal femoral medullary cavity parameters, and the femur was false. Body body number is positive correlation. Body weight and body mass index and isthmus outer diameter, cortical thickness exists in.6 DDH group T+20, T0, T-20, T isthmus, the location of isthmus is smaller than the other groups, the difference is statistically significant, but there is no statistical significance in other disease groups, and there is XS in the femoral stem type in the clinical operation process of the patients with.DDH, S is the main.7 T0, T-20 is at the T-20 in the course of clinical operation. There was no statistical significance between different types of femoral stem models, and there was no statistical significance in T+20. The selection of CFP femur handle model was positively correlated with T0 and T-20, and there was no significant correlation with T+20. There was a strong positive correlation between the inner diameter of.8 isthmus pulp cavity and the inner pulp cavity of the CFP handle, and there was a strong positive correlation with.9 CFI, MCFI, Noble classification and share with the selection of the femur stalk type. There is a strong correlation between the selection of the bone handle and the weak correlation between the selection of DCFI and the type of the femoral stem. Conclusion: the proximal femoral medullary diameter of the 1 Chinese people is smaller than that of the European beauty. The inverted champagne bottle cavity is larger than the European beauty. The model of the CFP prosthesis in the operation is concentrated on XS-M and does not present a normal distribution to the small prosthesis, indicating the C based on the large bone design of the westerners. There is a positive correlation between the height of the FP prosthesis relative to the large.2 of the country and the proximal femoral medullary parameters of the femur and the type of the CFP femur. As the height increases, the proximal femoral medullary diameter of the femur becomes larger, and the use of the CFP prosthesis also increases the comparison between the different.3 groups. The proximal femoral medullary diameter of the hip dysplasia is smaller and the operation needs less preparation. The model prosthesis, or the preparation of the.4 CFP prosthesis of the small distal hip prosthesis and the midpoint of the small trochanter, the midpoint level of the small rotors, 20mm, the internal diameter of the isthmus pulp cavity are closely related, the larger patients of the medullary cavity at three points need to use the larger type CFP prosthesis.5 CFI, and MCFI can respond well to the shape of the proximal and large trochanteric lumen of the femoral bone and the model of the CFP prosthesis. Highly correlated, the smaller the CFI and MCFI, the larger the CFP prosthesis type.

【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】：2017
【分類號(hào)】：R687.4

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