本文選題：PINCER型股骨髖臼撞擊綜合征 + PINCER型股骨髖臼撞擊綜合征X線影像學征象　； 參考：《遵義醫(yī)學院》2017年碩士論文

【摘要】：目的:通過對比髖關節(jié)正位片上有PINCER型股骨髖臼撞擊癥(FAI)影像學征象存在者和無任何異常征象者的髖關節(jié)活動度,去研究當髖關節(jié)正位片上存在PINCER型FAI征象時髖關節(jié)活動度的變化。方法:篩選出2010年至2016年大連大學附屬中山醫(yī)院所有的髖關節(jié)正位片,經擬定的排除標準后,對于非標準髖關節(jié)正位片的患者,再次行標準髖關節(jié)正位片的拍攝:病人仰臥于攝影臺上,人體正中矢狀面垂直臺面,兩下肢伸直,雙足輕度內旋10°-15°自然并攏,中心線通過髂前上棘連線中點與恥骨聯(lián)合上緣連線的中點,曝光范圍包括整個骨盆,管電壓65KV,攝影距離為110-120cm。由兩位高年資影像學醫(yī)師在雙盲的情況下對上述髖關節(jié)正位片進行PINCER型FAI影像學征象的篩選,共有265例(430髖);同時篩選出50例(100髖)無任何異常影像學征象的髖關節(jié)。根據有無PINCER型FAI影像學征象將上述患者分為研究組(265例,430髖)和對照組(50例,100髖)。并根據每種PINCER型FAI線影像學征象在髖關節(jié)正位片上的表現情況,將研究組分為5個亞組:A組:“交叉征”組;B組:“髖臼過深”組;C組:“交叉征+髖臼過深”組;D組:“髖臼過深+后壁征”組;E組:“髖臼突出+后壁征”組。采用統(tǒng)一的測量方法對上述所有髖關節(jié)進行活動度(前屈、后伸、內旋、外旋、內收、外展)的測量,同時檢查前后撞擊試驗及“4”字試驗,記錄結果。研究組中每個亞組均與對照組做對比,并用SPSS17.0軟件中獨立樣本T檢驗對兩組關節(jié)活動度的差異進行統(tǒng)計學分析;采用卡方檢驗對前后撞擊試驗及“4”字試驗陽性率的差異進行統(tǒng)計學分析。結果:上述樣本全部納入結果分析,兩組樣本的一般資料相比無統(tǒng)計學差異。研究結果如下:(1)“交叉征”組:共有101例,結果表明髖關節(jié)正位片上存在“交叉征”征象時髖關節(jié)活動度與正常組相比是有差異的,主要表現在屈曲(P0.001),內旋(P0.001),內收(P0.001),以及前撞擊實驗陽性(P0.001);(2)“髖臼過深”組:在該項研究中共123例,其關節(jié)活動度與正常組相比無明顯變化,前屈(P=0.888),后伸(P=0.878),內旋(P=0.082),外旋(P=0.336),內收(P=0.845),外展(P=0.806),前后撞擊試驗及“4”字試驗均為陰性;(3)“交叉征+髖臼過深”組:共77例,關節(jié)活動度異常主要表現在屈曲(P0.001),內旋(P=0.002),內收(P0.001),前撞擊試驗陽性(P0.001);(4)“后壁征”+髖臼過深”組:共67例,其關節(jié)活動度的變化表現在內旋(P0.001),外旋(P0.001),后伸(P0.001),前后撞擊實驗均為陽性(P0.001),“4”字試驗陽性(P0.001)。(5)“后壁征+髖臼突出”共66例,其關節(jié)活動度表現為內旋(P0.001),外旋(P0.001),內收(P0.001),后伸(P0.001),前后撞擊試驗及“4”字試驗陽性率差異有統(tǒng)計學意義(P0.001)。結論:當髖關節(jié)正位片上只存在“交叉征”征象時,髖關節(jié)活動度與正常髖關節(jié)相比是有差異的。而單純的“髖臼過深”存在時對髖關節(jié)的活動度沒有明顯的影響。此外,當存在后壁過度覆蓋這種解剖學異常時(后壁征),除了有后撞擊試驗陽性外,前撞擊試驗及“4”字試驗也會表現為陽性。
[Abstract]:Objective: To study the changes in hip mobility in the presence of PINCER type FAI signs on the hip joint orthographic film by comparing the hip motion of the PINCER type femoral acetabular impingement (FAI) imaging findings and no abnormal signs on the hip joint orthotopic films. Methods: the Zhongshan Medicine Affiliated to the Dalian University from 2010 to 2016 was selected. After the proposed exclusion criteria, after the proposed exclusion criteria, for the patients with nonstandard hip joint position, the patients were taken again on the standard hip joint film: the patient was lying on the camera, the median sagittal vertical surface of the human body, the two lower extremity straightening, the mild internal rotation of the bipedal 10 degrees -15 degrees, and the center line through the anterior superior iliac spine line. Point with the middle point of the joint superior line of the pubis, the exposure range includes the entire pelvis, the tube voltage 65KV, and the distance of the photographing of 110-120cm. by two senior year imaging physicians to screen the PINCER FAI imaging signs of the above hip joint under the double blindness, with a total of 265 cases (430 hips); at the same time, 50 cases (100 hips) have no abnormality. According to the PINCER FAI imaging signs, the above patients were divided into the study group (265 cases, 430 hips) and the control group (50 cases, 100 hips). The study group was divided into 5 subgroups according to the performance of each PINCER type FAI line image on the hip joint: the A group: the "cross sign" group; the B group: "the over depth of the acetabulum." Group C: group C: "cross sign + acetabular deep" group; group D: "acetabular deep + posterior wall sign" group; group E: "acetabular protruding + posterior wall sign" group. The measurements of all hip joint activity (anterior flexion, extension, internal rotation, external rotation, adduction, abduction) were measured by a unified method, and the results of the impact test and the "4" test were recorded before and after examination. Record the results. Each group in the study group was compared with the control group, and the differences of the two groups of joint activity were statistically analyzed with the independent sample T test in the SPSS17.0 software. The difference between the positive rate of the front and back impact test and the "4" test was statistically analyzed with chi square test. The results were all included in the results analysis and two groups of samples. There was no statistical difference in the general data. The results were as follows: (1) the "cross sign" group: a total of 101 cases, the results showed that the hip joint activity was different from the normal group when there was "cross sign" sign on the hip joint, mainly in flexion (P0.001), internal rotation (P0.001), adduction (P0.001), and positive impact test positive. (P0.001): (2) "too deep acetabulum" group: 123 cases in this study, there were no obvious changes in the joint activity compared with the normal group, the flexion (P=0.888), the extension (P=0.878), the internal rotation (P=0.082), the external rotation (P=0.336), the adduction (P=0.845), the abduction (P= 0.806), the front and back impact test and the "4" test were all negative; (3) "cross sign + excessive acetabulum" group: a total of 7 In 7 cases, the abnormality of joint activity was mainly in flexion (P0.001), internal rotation (P=0.002), adduction (P0.001), positive impact test positive (P0.001); (4) "posterior wall sign" + excessive acetabulum group: a total of 67 cases (P0.001), external rotation (P0.001), extension (P0.001), and posterior impact test were positive (P0.001) and "4" test. Test positive (P0.001). (5) "posterior wall sign + acetabular protrusion" in 66 cases, its joint activity was internal rotation (P0.001), external rotation (P0.001), adduction (P0.001), extension (P0.001), the positive rate of front and back impact test and "4" test were statistically significant (P0.001). Conclusion: when there is only "cross sign" sign on the hip joint position, hip joint The activity degree is different from that of the normal hip joint. But the simple "acetabulum too deep" has no significant influence on the activity of the hip joint. In addition, when the posterior wall overlay the anatomic abnormalities (the posterior wall sign), the front impact test and the "4" word test will also be positive except for the positive post impact test.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R684

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