發(fā)布時(shí)間：2019-06-06 04:11

【摘要】：目的:股骨粗隆間骨折已經(jīng)廣泛采用PFNA治療,PFNA與股骨髓腔解剖形態(tài)的匹配性也一直存在爭(zhēng)議。本研究通過醫(yī)學(xué)圖像處理軟件對(duì)成人股骨干CT進(jìn)行處理,測(cè)量股骨近端髓腔橫截面不同方向上的直徑,并對(duì)多個(gè)樣本的測(cè)量數(shù)據(jù)進(jìn)行統(tǒng)計(jì)。觀察股骨近端髓腔直徑的變化有無統(tǒng)計(jì)學(xué)意義,并找出最小直徑的位置變化規(guī)律。根據(jù)測(cè)量所得數(shù)據(jù),分析PFNA與髓腔的匹配性,進(jìn)一步完善PFNA的設(shè)計(jì)與臨床應(yīng)用。方法:采集行股骨全長(zhǎng)CT掃描患者共60例,篩選其中符合研究條件患者50例,其中男性25例,女性25例,年齡均在50-90歲之間。將其股骨CT掃描數(shù)據(jù)用醫(yī)學(xué)圖像處理軟件MIMICS10.01處理,測(cè)量股骨近端的解剖參數(shù),包括大粗隆頂點(diǎn)至小粗隆水平距離,大粗隆頂點(diǎn)至股骨髁距離。小粗隆水平至股骨峽部分別取若干水平截面,每平面間隔1cm,在每個(gè)截面上分別對(duì)8個(gè)方向上的直徑進(jìn)行測(cè)量。根據(jù)所測(cè)量數(shù)據(jù),統(tǒng)計(jì)其分布規(guī)律,并對(duì)男女兩組的測(cè)量值運(yùn)用統(tǒng)計(jì)學(xué)軟件以檢驗(yàn)其差異性。計(jì)算其比值以總結(jié)其是否具有臨床意義。根據(jù)所測(cè)得的解剖參數(shù)與PFNA參數(shù)相比較,衡量其匹配性。結(jié)果:1.大粗隆頂點(diǎn)至小粗隆平面距離:男性組a值變化范圍為4.80-6.40cm;女性組中a值變化范圍4.70-5.50cm。男性組平均值為5.456cm,女性組平均值4.976cm,兩組之間存在統(tǒng)計(jì)學(xué)差異。2.髓腔最小直徑:男女性在髓腔最小直徑上無明顯差異性分布,50例樣本平均值為10.718mm。3.股骨髓腔最小直徑出現(xiàn)位置與大粗隆頂點(diǎn)距離:男性平均值17.424cm,女性平均值16.886cm,男性大于女性。4.K值范圍38.88%-46.92%。兩組之間無明顯統(tǒng)計(jì)學(xué)差異。5.最小髓腔直徑:男性組髓腔最小直徑范圍:8.19-14.18mm,女性組髓腔最小直徑范圍:8.99-12.61mm,兩組之間髓腔最小直徑無統(tǒng)計(jì)學(xué)差異,總體平均值為10.72mm。結(jié)論:1.老年股骨髓腔最小直徑出現(xiàn)的平面位置與股骨干長(zhǎng)度具有一定比例關(guān)系,此比例值的分布相對(duì)集中。男性出現(xiàn)最小直徑的位置要比女性低。2.絕大多數(shù)(82%)樣本髓腔的最小直徑均出現(xiàn)于D0方向,也就是股骨的冠狀徑方向。證明臨床中下肢中立位x片上的髓腔內(nèi)徑基本反映出了髓腔的最小值。術(shù)前運(yùn)用下肢中立位x片來評(píng)估髓腔直徑及選取主釘規(guī)格是有意義的。3,臨床上存在一定數(shù)量髓腔最小直徑≤9mm的病人(分布比例為10%),考慮PFNA均要通過其最小直徑所在平面,因此直徑更小的主釘是有需求的。
[Abstract]:Objective: PFNA has been widely used in the treatment of intertrochanter fracture of femur, and the matching of PFNA and anatomical morphology of bone marrow cavity has been controversial. In this study, the CT of adult thigh shaft was processed by medical image processing software, and the diameters of the transverse section of the proximal pulp cavity of the femurs were measured, and the measured data of several samples were statistically analyzed. The changes of the diameter of the proximal medullary cavity were observed and the position of the minimum diameter was found out. According to the measured data, the matching between PFNA and pulp cavity was analyzed, and the design and clinical application of PFNA were further improved. Methods: a total of 60 patients with full-length CT scan of femurs were collected. 50 of them were selected, including 25 males and 25 females, all of whom were between 50 and 90 years of age. The CT scanning data of femurs were processed with medical image processing software MIMICS10.01 to measure the anatomical parameters of proximal femurs, including the horizontal distance from the apex of large trochanter to small trochanter and the distance from the apex of large trochanter to the condyle of femur. A number of horizontal sections were taken from the small trochanter level to the isthmus of the femurs, with an interval of 1 cm per plane, and the diameters in eight directions were measured on each section. According to the measured data, the distribution law was counted, and the statistical software was used to test the difference between the two groups. The ratio was calculated to summarize its clinical significance. According to the measured anatomical parameters and PFNA parameters, the matching property was measured. Result: 1. The distance from the peak of large trochanter to the plane of small trochanter: the range of a value in male group was 4.80 鈮，

本文編號(hào)：2494057