【摘要】：背景DDH股骨近端形態(tài)變異較大，三維重建技術(shù)的成熟為我們提供了一種更加有效的方法進(jìn)行DDH股骨近端形態(tài)的研究。但截止目前，國內(nèi)外在DDH股骨近端的三維重建測量的研究依然非常匱乏。 目的通過對成人發(fā)育性髖關(guān)節(jié)發(fā)育不良（Devlopmental dysplasia of the hip，DDH）股骨近端進(jìn)行三維重建并測量相關(guān)的解剖學(xué)參數(shù)，，加深對DDH股骨近端解剖變異的三維形態(tài)學(xué)認(rèn)識，用以指導(dǎo)術(shù)前計(jì)劃及假體設(shè)計(jì)。 方法選擇2012年1月至2014年12月，我院收治的成人髖關(guān)節(jié)發(fā)育不良患者共38例（47髖）；對照組選擇成人健康志愿者31例（31髖）。所有患髖均進(jìn)行CT掃描和骨盆正位片檢查，按照Crowe分型方法進(jìn)行分型。將獲得的髖關(guān)節(jié)CT數(shù)據(jù)導(dǎo)入Mimics17.0軟件進(jìn)行重建，測量以下參數(shù)：頸干角、頭頸長、偏心距、大粗隆高點(diǎn)高度、股骨頭高度、峽部高度，峽部內(nèi)徑（Di）、小粗隆最突出點(diǎn)近側(cè)10mm髓腔內(nèi)徑（DT+10）和小粗隆最突出點(diǎn)遠(yuǎn)側(cè)20mm髓腔內(nèi)徑（DT-20）；計(jì)算DT+10/DT-20、DT+10/Di和DT-20/Di的值。應(yīng)用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)分析，對四組之間各參數(shù)差異進(jìn)行方差分析，并對組與組之間的差異性進(jìn)行多重比較（LSD法）。設(shè)定P 0.05為顯著性差異指標(biāo)。 結(jié)果正常人、CroweI型、CroweII或III型及CroweIV型的頸干角分別為：131.8±5.9°，131.8±7.1°，131.7±6.5°，122.8±11.4°；正常人、CroweI型、CroweII或III型及CroweIV型頭頸長分別為：53.1±4.4mm，48.6±6.7mm，50.4±4.7mm，44.6±6.6mm；正常人、CroweI型、CroweII或III型及CroweIV型偏心距分別為：39±4.3mm，35.8±5.8mm，37.3±4.2mm，36.1±4.3mm；正常人、CroweI型、CroweII或III型及CroweIV型DT+10分別為：24.6±2.5mm，25.2±3.4mm，21.9±4.2mm，17.2±5.3mm；正常人、CroweI型、CroweII或III型及CroweIV型DT-20分別為：17.1±2.3mm，17.1±2.3mm，16.3±3.2mm，12.2±3mm；正常人、CroweI型、CroweII或III型及CroweIV型Di分別為：10.1±1.4mm，9.9±2.2mm，8.3±1.8mm，8.7±1.7mm；正常人、CroweI型、CroweII或III型及CroweIV型大粗隆高點(diǎn)高度分別為：6.1±3.9mm，8.9±7.2mm，7.5±3.3mm，12.1±6.1mm；正常人、CroweI型、CroweII或III型及CroweIV型股骨頭高度分別為：46.5±6.2mm，39.6±6.5mm，39.1±4.2mm，38.8±8.6mm；正常人、CroweI型、CroweII或III型及CroweIV型峽部高度分別為：116.5±10.6mm，106.2±13.8mm，108.8±10.5mm，94.1±19.7mm；正常人、CroweI型、CroweII或III型及CroweIV型DT+10/DT-20分別為：1.5±0.2，1.5±0.2，1.4±0.3，1.4±0.2；正常人、CroweI型、CroweII或III型及CroweIV型DT+10/Di分別為：2.5±0.4，2.6±0.5，2.7±0.6，2±0.4；正常人、CroweI型、CroweII或III型及CroweIV型DT-20/Di分別為：1.7±0.2，1.8±0.3，1.9±0.3，1.4±0.2。 Crowe I-III型DDH頸干角與正常人無明顯差異，Crowe IV型DDH頸干角顯著小于正常人和Crowe I-III型DDH；Crowe IV型DDH頭頸長顯著小于Crowe I-III型DDH；Di在正常人和Crowe I型間無顯著差異，Crowe II-III型和Crowe IV型間無顯著差異，但前兩者與后兩者間存在顯著差異；DT+10/DT-20和偏心距在正常人和DDH組及DDH不同組之間無顯著的統(tǒng)計(jì)學(xué)差異；DT+10、DT-20、DT+10/Di及DT-20/Di在Crowe IV型DDH顯著小于Crowe I-III型DDH；Crowe IV型DDH大粗隆高點(diǎn)高度顯著大于正常人和Crowe I-III型DDH；DDH各組股骨頭高度顯著小于正常人；CroweIV型峽部高度顯著小于正常人和Crowe I-III型DDH。 結(jié)論DDH股骨頸干角不大于正常人，相反，Crowe IV型DDH頸干角顯著減�。幌鄬τ贑rowe I-III型DDH，Crowe IV型DDH的髓內(nèi)和髓外參數(shù)變異更顯著：大粗隆高點(diǎn)和峽部高度更高，小粗隆水平的近端髓腔縮窄更為顯著。
[Abstract]:Background DDH has a large variation in the morphology of the proximal femur. The maturation of the three-dimensional reconstruction technique provides a more effective method for the study of the proximal femur morphology of the DDH. But at present, the study of the three-dimensional reconstruction of the proximal femur at home and abroad is still very scarce at home and abroad.
Objective to reconstruct the proximal femur of the adult developmental hip dysplasia (Devlopmental dysplasia of the hip, DDH) and measure the related anatomical parameters to deepen the three-dimensional morphological understanding of the anatomical variation of the proximal femur of the femur, so as to guide the pre operation plan and the design of the false body.
Methods from January 2012 to December 2014, 38 adult patients with dysplasia of hip joint (47 hips) were treated in our hospital. In the control group, 31 adult healthy volunteers (31 hips) were selected. All the affected hips were examined by CT scan and pelvis orthotopic examination and classified according to the Crowe typing method. The acquired hip CT data were introduced into the Mimics17.0 software. The following parameters were measured: the neck dry angle, head and neck, eccentricity, high trochanter height, femoral head height, isthmus height, isthmus diameter (Di), the proximal 10mm intramedullary diameter (DT+10) and the distal 20mm intramedullary diameter (DT-20) of the most protruding point of the trochanter, and the value of DT+10/DT-20, DT+10/Di and DT-20/Di. Statistical analysis was carried out to analyze the variance of the parameters between the four groups and to compare the differences between the groups and the groups (LSD). The P 0.05 was set as a significant difference index.
Results normal people, type CroweI, CroweII or III and CroweIV type were respectively 131.8 + 5.9 degrees, 131.8 + 7.1 degrees, 131.7 + 6.5 degrees, 122.8 + 11.4 degrees; CroweI, CroweII or III type and CroweIV type head and neck length were respectively 53.1 + 4.4mm, 48.6 + 6.7mm, 50.4 + 4.7MM, 44.6 + 6.6mm. Type V eccentricity is 39 + 4.3mm, 35.8 + 5.8mm, 37.3 + 4.2mm and 36.1 + 4.3mm, and CroweI type, CroweII or III and CroweIV DT+10 respectively are 24.6 +, 25.2 + 3.4mm, 21.9 +, 17.2, respectively: 17.1 +, 17.1 +, 16.3 +, 12.2 + M, normal people, type CroweI, CroweII or III and CroweIV Di were 10.1 + 1.4mm, 9.9 + 2.2mm, 8.3 + 1.8mm, 8.7 + 1.7mm, and normal people, CroweI type, 6.1 +, 8.9 +, 7.5, 12.1, respectively. The head height was 46.5 + 6.2mm, 39.6 + 6.5mm, 39.1 + 4.2mm and 38.8 + 8.6MM, and the normal people were 116.5 + 10.6mm, 106.2 + 13.8mm, 108.8 + 10.5mm, 94.1 + 19.7mm, respectively, and normal people, respectively, 1.5 + 1.4 + 0.2, and normal people, type CroweI, CroweII or III and CroweIV DT+10/Di respectively: 2.5 + 0.4,2.6 + 0.5,2.7 + 0.6,2 + 0.4, and normal people, CroweI, CroweII or III and CroweIV type respectively: 1.7 +
There is no significant difference between the Crowe I-III type DDH neck stem angle and the normal person. The Crowe IV type DDH neck dry angle is significantly smaller than the normal and Crowe I-III DDH, and Crowe IV DDH head and neck length is significantly smaller than that of the normal person. There was no significant difference in DT+10/DT-20 and eccentricity between the normal people and the DDH group and the different DDH groups. DT+10, DT-20, DT+10/Di and DT-20/Di were significantly smaller than those of Crowe I-III type Crowe IV DDH. The height of CroweIV isthmus was significantly less than that of normal persons and Crowe I-III DDH..
Conclusion the femoral neck dry angle of DDH is not greater than that of normal people. On the contrary, the Crowe IV type DDH neck dry angle decreases significantly. Relative to Crowe I-III DDH, the intramedullary and extramedullary parameters of Crowe IV DDH are more significant: the high tuberosity point and the isthmus height are higher, and the proximal intramedullary coarctation of the small trochanter level is more significant.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.1

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馬如宇,王冬梅,薛文東,戴\戎,王成燾;基于X線片三維重建股骨近端髓腔[J];北京生物醫(yī)學(xué)工程;2004年04期

2 薛文東;戴克戎;龍公;;中國人股骨上段幾何特征研究[J];北京生物醫(yī)學(xué)工程;2006年01期

3 陸晴友,吳岳嵩,王成燾;股骨近端解剖形態(tài)的CT三維重建與分析[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2005年09期

4 雒文彬;左建林;王金成;;成人發(fā)育性髖關(guān)節(jié)脫位分型及治療策略[J];國際骨科學(xué)雜志;2013年03期

5 張曉敏;曹力;;人工全髖關(guān)節(jié)置換術(shù)后脫位原因及治療進(jìn)展[J];中國骨與關(guān)節(jié)損傷雜志;2014年02期

6 李銳;;人工髖關(guān)節(jié)置換數(shù)字化研究新進(jìn)展[J];包頭醫(yī)學(xué)院學(xué)報(bào);2014年03期

7 呂明;吳堅(jiān);柳劍;竇勇;周一新;楊德金;;全髖置換術(shù)后髖臼和股骨假體聯(lián)合前傾角的CT研究[J];重慶醫(yī)學(xué);2014年24期

8 趙晶鑫;蘇秀云;趙U

本文編號：2140790