【摘要】：目的：通過回顧成人股骨頭壞死影像學(xué)資料,分析日常生活中股骨頭髖臼的應(yīng)力分布特點及股骨頭血供特點,統(tǒng)計分析出股骨頭壞死區(qū)域與股骨頭應(yīng)力峰值區(qū)域及血供區(qū)域的相關(guān)性,提出股骨頭壞死應(yīng)力機(jī)制假說,強(qiáng)調(diào)應(yīng)力因素在股骨頭壞死發(fā)生及發(fā)展過程中的作用；把補(bǔ)益肝腎、強(qiáng)筋壯骨治法放在與活血化瘀、改善循環(huán)同等重要位置,從而更好地在臨床上指導(dǎo)股骨頭壞死這一骨科疑難病的預(yù)防和診治。方法：收集廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院2014年4月～2015年4月確診為股骨頭壞死患者的髖關(guān)節(jié)螺旋CT影像資料共23份(40髖),其中男性15例,女性8例；年齡18-47歲,平均年齡33歲；ARCO分期：Ⅰ期2髖,Ⅱ期16髖,Ⅲ期21髖,Ⅳ期1髖；發(fā)病原因：創(chuàng)傷性壞死5髖,激素性壞死18髖,酒精性壞死14髖,特發(fā)性壞死3髖。運用Mimics軟件分別重建其股骨頭三維影像,確定壞死區(qū)域及相對應(yīng)壞死中心點。根據(jù)股骨頭日常生活中承受應(yīng)力的特點,將股骨頭劃分為頂柱、前側(cè)柱、外側(cè)柱及后側(cè)柱四個區(qū)域,其中頂柱、前側(cè)柱、外側(cè)柱為股骨頭日常承受應(yīng)力較集中區(qū)域,后側(cè)柱為股骨頭血供分布較集中區(qū)域。擬定股骨頭中垂線周圍40度范圍為頂柱,其外側(cè)為外側(cè)柱,前方為前側(cè)柱,后方為后側(cè)柱。將各病例股骨頭壞死中心點與股骨頭應(yīng)力柱區(qū)域一一對應(yīng),收集數(shù)據(jù),建立數(shù)據(jù)庫,進(jìn)行數(shù)據(jù)統(tǒng)計分析。結(jié)果：23份病例髖關(guān)節(jié)螺旋CT影像資料(40髖)均成功進(jìn)行三維重建,其中壞死中心點位于頂柱的有4髖,位于前側(cè)柱的有8髖,位于外側(cè)柱的26髖,位于后側(cè)柱的2髖,經(jīng)單樣本卡方檢驗(X2=1.11,P0.05),差異有統(tǒng)計學(xué)意義。結(jié)論：①日常生活中股骨頭應(yīng)力集中區(qū)域在股骨頭頂柱及前外側(cè)柱,股骨頭發(fā)生壞死及塌陷的部位主要集中在此區(qū)域；②股骨頭血液供應(yīng)主要分布在股骨頭后方,股骨頭壞死及塌陷反而較少發(fā)生在該區(qū)域,壞死分布與血供分布并不相符；
[Abstract]:Objective: To analyze the stress distribution and blood supply of femoral head and acetabulum in daily life by reviewing the imaging data of adult femoral head necrosis of femoral head, and to analyze the correlation between femoral head necrosis area and femoral head stress peak area and blood supply area. Methods: The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from April 2014 to April 2015 was collected. Twenty-three cases (40 hips) of femoral head necrosis were diagnosed by spiral CT, including 15 males and 8 females, aged 18-47 with an average age of 33; ARCO staging: 2 hips in stage I, 16 hips in stage II, 21 hips in stage III, and 1 hip in stage IV; pathogenesis: traumatic necrosis of 5 hips, hormone necrosis of 18 hips, alcoholic necrosis of 14 hips, and idiopathic deterioration. Three hips were dead.Three-dimensional images of the femoral head were reconstructed with Mimics software to determine the necrotic area and the corresponding necrotic center.According to the characteristics of daily stress of the femoral head,the femoral head was divided into four areas:the top column,the front column,the lateral column and the posterior column. The central point of femoral head necrosis was corresponded with the stress column area of femoral head. Data were collected, a database was established, and the data were statistically analyzed. Results: The spiral CT images of 23 cases (40 hips) were reconstructed successfully. There were 4 hips with necrosis center at apex, 8 hips with anterior column, 26 hips with lateral column and 2 hips with posterior column. The difference was statistically significant by single sample chi-square test (X2 = 1.11, P 0.05). The stress concentration area of the femoral head is located in the top column and anterolateral column of the femoral head, and the necrosis and collapse of the femoral head are mainly concentrated in this area. The blood supply of the femoral head mainly distributes behind the femoral head, whereas the necrosis and collapse of the femoral head rarely occur in this area.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.8

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