本文選題：髖臼發(fā)育不良 + 成人�。� 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:髖臼發(fā)育不良是一種發(fā)育性畸形,1939年,Wiberg首先提出髖臼發(fā)育不良(Acetabular Dysplasia,AD)的概念[1],并用CE角(centre edge angle)CE角≤20°來診斷成人髖臼發(fā)育不良。由于髖臼發(fā)育不良股骨頭覆蓋不全,導(dǎo)致髖關(guān)節(jié)負(fù)重狀態(tài)發(fā)生改變,關(guān)節(jié)軟骨退變加重,最終導(dǎo)致發(fā)生髖關(guān)節(jié)骨性關(guān)節(jié)炎[2.3]。有報(bào)道[4]稱髖關(guān)節(jié)骨性關(guān)節(jié)炎患者中20%~50%有髖臼發(fā)育不良,髖臼發(fā)育不良在髖關(guān)節(jié)骨性關(guān)節(jié)炎的發(fā)病中起到了重要作用。髖臼發(fā)育不良患者早期無明顯癥狀,多在20-40歲逐漸出現(xiàn)癥狀,發(fā)現(xiàn)時(shí)多數(shù)病人已經(jīng)有了比較嚴(yán)重的髖關(guān)節(jié)骨性關(guān)節(jié)炎,應(yīng)用4種不同方法對(duì)成人的髖臼進(jìn)行X線測(cè)量,主要包括:CE角(centre edge angle)、Sharp角[5](acetabular angle of Sharp)、頭臼指數(shù)[6](acetabular head index AHI)及髖臼指數(shù)(acetabular index AI)為了能夠?qū)y臼發(fā)育不良早期做出診斷,進(jìn)行有效的干預(yù),目前對(duì)髖臼發(fā)育不良的研究越來越受到重視。目前對(duì)成人髖臼發(fā)育不良的影像學(xué)診斷方法多種多樣,標(biāo)準(zhǔn)不統(tǒng)一,各種測(cè)量方法都有一定的局限性,且同一病人,應(yīng)用不同測(cè)量方法得出的診斷結(jié)論可能不同。為此提出一種新的測(cè)量指標(biāo):股骨頭偏移度即以“淚滴”點(diǎn)為參照,通過測(cè)量股骨頭的橫向偏移度及縱向偏移度,觀察股骨頭向外、向上偏移的程度來診斷髖臼發(fā)育不良。通過對(duì)比臨床常用測(cè)量方法分析不同方法的優(yōu)劣,從而得出診斷成人髖臼發(fā)育不良更可靠地指標(biāo)。方法:本文通過篩選出河北醫(yī)科大學(xué)第三醫(yī)院2014年7月至2014年12月骨科門診就診者402例,進(jìn)行骨盆正位X線片檢查。X線片檢查由同一組人進(jìn)行。攝片方法統(tǒng)一標(biāo)準(zhǔn):檢查者平臥位,雙下肢伸直,第一趾趾尖端并攏垂直檢查床面,保持骨盆無旋轉(zhuǎn)及傾斜,管球與底片間距離是100厘米。納入標(biāo)準(zhǔn):由兩位放射學(xué)專家及骨病科專家鑒定為正常髖關(guān)節(jié)或髖臼發(fā)育不良。排除標(biāo)準(zhǔn):已知有神經(jīng)肌肉性疾病,合并其他畸形,嚴(yán)重的髖關(guān)節(jié)骨性關(guān)節(jié)炎合并髖臼外緣增生明顯者,嚴(yán)重骨盆傾斜、骨盆骨折及重度股骨頭壞死創(chuàng)傷性關(guān)節(jié)炎者。其中男性199例,女性203例,年齡為18-91歲,平均年齡51.1歲,體重為42.5-98公斤,平均體重65.1公斤,身高為150-185厘米,平均身高167厘米。三次取平均值測(cè)量每個(gè)人雙側(cè)髖臼共804例髖關(guān)節(jié)的CE角、Sharp角、頭臼指數(shù)AHI、髖臼指數(shù)AI及股骨頭縱向偏移度及橫向偏移度。股骨頭橫向偏移度:股骨頭中心點(diǎn)到經(jīng)同側(cè)淚滴中點(diǎn)垂線的垂直距離a與髖臼外上緣到同側(cè)淚滴垂線的垂直距離b的百分比,即:(a/b)%。股骨頭縱向偏移度:股骨頭中心點(diǎn)到雙側(cè)淚滴最低點(diǎn)連線的垂直距離c與髖臼外上緣到雙側(cè)淚滴最低點(diǎn)連線的垂直距離d的百分比,即:(c/d)%。以CE角和Sharp角均在正常范圍內(nèi)判定為正常髖關(guān)節(jié),正常髖關(guān)節(jié)496例,髖臼發(fā)育不良308例。通過統(tǒng)計(jì)分析得出正常髖關(guān)節(jié)股骨頭偏移度正常參考值范圍。通過一致性檢驗(yàn)(Kappa檢驗(yàn))將股骨頭偏移度測(cè)量法與CE角、Sharp角進(jìn)行對(duì)比,Sharp角與CE角對(duì)比、頭臼指數(shù)AHI及髖臼指數(shù)AI分別與CE角進(jìn)行對(duì)比,分析各種方法之間診斷的一致性是否有差別。以CE角為標(biāo)準(zhǔn),觀察股骨頭偏移度診斷髖臼發(fā)育不良的敏感度及特異度,并分析股骨頭偏移度方法的診斷髖臼發(fā)育不良的效力。結(jié)果:CE角20°且Sharp角45°的正常髖關(guān)節(jié)496例,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),樣本數(shù)據(jù)不符合正態(tài)分布,應(yīng)用百分位數(shù)法制定95%的正常參考值范圍分別是:股骨頭橫向偏移度:80.08%,股骨頭縱向偏移度:45.15%。根據(jù)股骨頭橫向偏移度和縱向偏移度均在正常值范圍內(nèi)來確定正常髖關(guān)節(jié),股骨頭橫向偏移度或縱向偏移度異常時(shí)診斷髖臼發(fā)育不良。一致性檢驗(yàn)結(jié)果:股骨頭偏移度測(cè)量法和CE角測(cè)量法及Sharp角測(cè)量法陽性率無統(tǒng)計(jì)學(xué)差異,新測(cè)量方法與CE角、Sharp角的診斷一致性較好,新方法與CE角測(cè)量法比較的Kappa值=0.565,P=0.353,新方法與Sharp角測(cè)量法比較的Kappa值=0.401,P=0.125。與CE角測(cè)量法比較,新方法的靈敏度為66.67%,特異度為88.89%,Sharp角測(cè)量法的靈敏度為68.86%,86.11%。頭臼指數(shù)法及髖臼指數(shù)法分別與CE角進(jìn)行對(duì)比,兩者與CE角的診斷一致性均較差。頭臼指數(shù)測(cè)量法與CE角測(cè)量法比較P=0.000,kappa值=0.470,敏感度90.7%,特異度66.84%,髖臼指數(shù)測(cè)量法與CE角測(cè)量法比較P=0.000,kappa值=0.090,敏感度95.17%,特異度19.27%。結(jié)論:1.股骨頭偏移度的測(cè)量可以作為診斷髖臼發(fā)育不良的一個(gè)較好的指標(biāo),股骨頭橫向偏移度正常值為80.08%,股骨頭縱向偏移度正常值為45.15%。當(dāng)成人髖臼股骨頭偏移度有一項(xiàng)超過上述正常值時(shí)即可以診斷為髖臼發(fā)育不良。2.股骨頭偏移度的測(cè)量診斷髖臼發(fā)育不良,方法簡(jiǎn)單,測(cè)量誤差相對(duì)較小,為診斷成人髖臼發(fā)育不良提供了一個(gè)新的可靠的診斷標(biāo)準(zhǔn)。3.成人髖臼發(fā)育不良的診斷中,與其他幾個(gè)指標(biāo)對(duì)比,髖臼指數(shù)的測(cè)量誤差最大,診斷效力最低。CE角及頭臼指數(shù)均是反應(yīng)股骨頭向外脫位的程度,而股骨頭縱向及橫向偏移度的測(cè)量能夠全面的評(píng)價(jià)股骨頭向外及向上脫位的趨勢(shì),測(cè)量時(shí)受髖臼外緣骨贅增生等因素影響較小,有顯著的優(yōu)勢(shì)。
[Abstract]:Objective: acetabular dysplasia is a developmental malformation. In 1939, Wiberg first proposed the concept [1] of Acetabular Dysplasia (AD), and used CE angle (centre edge angle) CE angle less than 20 degrees to diagnose adult acetabular dysplasia. The aggravation of cartilage degeneration, which eventually leads to the occurrence of osteoarthritis of the hip joint [2.3]., has reported that [4] said that 20%~50% has acetabular dysplasia in the patients with hip osteoarthritis, and acetabular dysplasia plays an important role in the pathogenesis of hip osteoarthritis. Most patients have severe hip osteoarthritis at the time of discovery. 4 different methods are used to measure the adult's acetabulum by 4 different methods, including centre edge angle, Sharp [5] (acetabular angle of Sharp), the [6] index of the head molars and the acetabular index. It is possible to make an early diagnosis of acetabular dysplasia and intervene effectively. The current research on acetabular dysplasia is becoming more and more important. There are various imaging diagnosis methods for adult acetabular dysplasia, the standard is not uniform, and various measurement methods have some limitations, and the same patient is used for different measurement methods. The results of the diagnosis may be different. A new measurement index is put forward: the deviation of the femoral head is based on the "tear drop" point. By measuring the lateral deviation and the longitudinal migration of the femoral head, the degree of the femoral head outward and upward is observed to diagnose the dysplasia of the acetabulum. The different methods are analyzed by comparing the common clinical measurement methods. The advantages and disadvantages of the method, so as to get a more reliable indicator of the diagnosis of adult acetabular dysplasia. Methods: in this paper, 402 cases in the Department of orthopedics of the Third Hospital of Hebei Medical University from July 2014 to December 2014 were selected and the X-ray examination of the pelvis was performed. The X-ray examination was carried out by the same group. Double lower extremity straightening, the first toe and toe point close together to check the surface of the bed vertically, keep the pelvis without rotation and tilt, the distance between the tube and the bottom is 100 centimeters. The inclusion criteria: two radiologists and orthopedics experts identified as normal hip joint or acetabular dysplasia. Exclusion criteria: known neuromuscular diseases, other malformations, serious The patients with hip osteoarthritis complicated with acetabular hyperplasia, severe pelvic tilt, pelvic fracture and severe traumatic arthritis of the femoral head, including 199 males and 203 women, age 18-91 years, average age 51.1 years, weight of 42.5-98 kg, average weight 65.1 kg, height of 150-185 cm, and average height of 167 centimeters. The CE angle, Sharp angle, the head index AHI, the acetabular index AI and the femoral head longitudinal deviation and lateral deviation were measured at the three times of each hip joint. The transverse deviation of the femoral head, the vertical distance from the center of the femoral head to the midpoint of the middle point of the teardrop, and the vertical distance from the upper margin of the acetabulum to the same side of the tear drop. The percentage of the B is: (a/b). The longitudinal deviation of the femoral head: the vertical distance of the vertical distance between the central point of the femoral head to the lowest point of the tear drop and the percentage of the vertical distance D of the lowest line between the upper margin of the acetabulum and the lower tear drop of the bilateral teardrop, that is, (c/d). The normal hip joint, 496 normal hip joints, and the acetabulum in 496 cases of normal hip joint, are determined in the normal range with the CE angle and Sharp angle. 308 cases of dysplasia. Through statistical analysis, the normal range of reference value of the femoral head offset of normal hip is obtained. Through the consistency test (Kappa test), the measurement of femoral head offset is compared with CE angle and Sharp angle, Sharp angle and CE angle are compared, the head index AHI and the acetabular index AI are compared with CE angle respectively, and the various methods are analyzed. Whether there was a difference in diagnostic consistency. Using CE angle as a criterion, the sensitivity and specificity of the femoral head offset in the diagnosis of acetabular dysplasia were observed, and the effectiveness of the femoral head offset method for the diagnosis of acetabular dysplasia was analyzed. Results: 496 cases of normal hip joint with CE angle 20 degrees and Sharp angle 45 degrees were statistically tested, the sample data did not conform to normal state. Distribution, the range of 95% normal reference values by the percentile method is the lateral deviation of the femoral head: 80.08%, the longitudinal deviation of the femoral head: 45.15%. determines the normal hip joint in the normal range according to the lateral migration degree and the longitudinal offset of the femoral head, and the diagnosis of the acetabular hair when the lateral displacement of the femoral head or the longitudinal deviation is abnormal. Poor fertility. Results of consistency test: there is no statistical difference between the measurement of femoral head deviation and the positive rates of CE angle measurement and Sharp angle measurement. The new method is in good agreement with the diagnosis of CE angle and Sharp angle. The Kappa value of the new method and CE angle measurement is =0.565, P=0.353, the Kappa value =0.401 of the new method and Sharp angle measurement, P=0.125, and P=0.125. Compared with the CE angle measurement, the sensitivity of the new method is 66.67%, the specificity is 88.89%, the sensitivity of the Sharp angle measurement is 68.86%. The 86.11%. head mortar index method and the acetabular index method are compared with the CE angle respectively. The diagnostic consistency between the two methods is poor with the CE angle. The head index measurement and CE angle measurement are P=0.000, kappa value =0.470, sensitivity. 90.7%, the specificity was 66.84%, the acetabular index measurement was compared with the CE angle measurement P=0.000, kappa value =0.090, the sensitivity 95.17%, and the specificity 19.27%. conclusion: the 1. femoral head offset can be used as a better indicator for the diagnosis of acetabular dysplasia, the normal value of the lateral displacement of the femoral head is 80.08%, and the normal value of the femoral head longitudinal deviation is 45. .15%. when an adult acetabular femoral head offset is more than the above normal value, it is possible to diagnose acetabular dysplasia.2. femoral head deviation in the diagnosis of acetabular dysplasia. The method is simple and the measurement error is relatively small, which provides a new and reliable diagnostic standard for the diagnosis of adult acetabular dysplasia,.3. adult acetabular development. In the good diagnosis, the measurement error of the acetabular index is the largest, the lowest.CE angle and the head index of the diagnostic effectiveness are the extent to the dislocation of the femoral head, while the longitudinal and lateral migration of the femoral head can evaluate the outward and upward dislocation of the femoral head and be increased by the external osteophyte of the acetabulum. The factors such as birth and other factors have little influence, and have significant advantages.
【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)】：R681.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 石永言;劉天婧;趙群;張立軍;吉士俊;;中國人髖關(guān)節(jié)髖臼指數(shù)和Sharp角正常值的測(cè)量[J];中華骨科雜志;2010年08期

2 張德昌,馬貴,王志純,褚瑞華;成人髖關(guān)節(jié)X線測(cè)量及其臨床應(yīng)用[J];實(shí)用放射學(xué)雜志;1993年11期

，

本文編號(hào)：2000019