本文選題：髖 + 骨盆　； 參考：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的探討TileB2型骨盆骨折致創(chuàng)傷性髖股撞擊征(femoroacetabular impingement, FAI)的發(fā)生發(fā)展機(jī)制,并分析影響TileB2骨盆骨折致創(chuàng)傷性髖股撞擊征發(fā)生的相關(guān)因素。 方法(1)3D模型建立階段：應(yīng)用Mimics軟件基于CT斷層圖像建立骨盆和髖關(guān)節(jié)3D數(shù)字模型,以模擬骨盆骨折和髖關(guān)節(jié)運(yùn)動(dòng)�；静襟E包括：①影像數(shù)據(jù)采集;②數(shù)據(jù)保存及傳輸；③閾值設(shè)定,影像編輯分割；④建立3D模型。(2)計(jì)算機(jī)模擬和影像測(cè)量階段：①結(jié)合髖關(guān)節(jié)運(yùn)動(dòng)特點(diǎn)和TileB2型骨盆骨折的側(cè)方壓迫損傷機(jī)制對(duì)髖關(guān)節(jié)旋轉(zhuǎn)中心和髂骨內(nèi)旋旋轉(zhuǎn)中心進(jìn)行設(shè)置；②計(jì)算機(jī)模擬TileB2型骨盆骨折和髖關(guān)節(jié)的運(yùn)動(dòng)；③通過模擬過程中的CT逆向顯示技術(shù)對(duì)髖關(guān)節(jié)進(jìn)行影像測(cè)量,測(cè)量距離為髖臼后緣與股骨頭頸結(jié)合處的皮質(zhì)骨與軟骨下骨的結(jié)合點(diǎn)(distance from the junction of the femoral neck and head to posterior edge of acetabulum, DFPA);④使用SPSS統(tǒng)計(jì)學(xué)軟件對(duì)測(cè)量數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。(3)臨床測(cè)讀方法驗(yàn)證階段：模擬TileB2型骨盆骨折,并應(yīng)用健-患側(cè)外展角差值法對(duì)其進(jìn)行測(cè)量,驗(yàn)證計(jì)算機(jī)模擬與臨床CT測(cè)讀診斷的互易性�；静襟E包括：①設(shè)置TileB2型骨盆骨折的旋轉(zhuǎn)中心；②模擬骨盆骨折；③采用健-患側(cè)外展角差值法對(duì)骨盆旋轉(zhuǎn)進(jìn)行CT影像測(cè)量；④配對(duì)t檢驗(yàn)統(tǒng)計(jì)分析。 結(jié)果(1)建立了適合髖關(guān)節(jié)運(yùn)動(dòng)學(xué)模擬和影像測(cè)量研究的骨盆和髖關(guān)節(jié)3D模型。其中股骨體積164838mm3,表面積19853mm2,由8884個(gè)三角形和4472個(gè)點(diǎn)組成；髂骨體積314552mm3,表面積59035mm2,由40366個(gè)三角形和20245個(gè)點(diǎn)組成。(2)對(duì)髖關(guān)節(jié)運(yùn)動(dòng)動(dòng)態(tài)模擬發(fā)現(xiàn)：正常髖關(guān)節(jié)運(yùn)動(dòng)并非直線性運(yùn)動(dòng),而是類似反比例函數(shù)曲線運(yùn)動(dòng)模式。曲線斜率逐漸減小,趨于水平,DFPA逐漸趨于常數(shù)值。當(dāng)髖臼內(nèi)旋時(shí),DFPA在呈整體性動(dòng)態(tài)下移趨勢(shì),曲線斜率減小,曲線逐漸趨于水平。靜態(tài)模擬發(fā)現(xiàn)：DFPA與髖臼內(nèi)旋角度呈直線性相關(guān),并計(jì)算出每個(gè)后伸角度時(shí)的回歸方程參數(shù)。(3)實(shí)驗(yàn)組與對(duì)照組測(cè)量結(jié)果總體比較無顯著差異(t=-1.983,P=0.067),其靈敏度為80.95%。 結(jié)論(1)應(yīng)用Mimics軟件建立骨盆和髖關(guān)節(jié)3D模型,操作便捷,模型外形逼真,數(shù)據(jù)精確,片面分布規(guī)則。Mimics軟件功能強(qiáng)大,可應(yīng)用3D模型模擬骨盆骨折和髖關(guān)節(jié)運(yùn)動(dòng),其模擬過程可在CT斷層掃描影像界面實(shí)時(shí)逆向顯示,能夠?qū)ζ溥M(jìn)行精確地影像學(xué)測(cè)量。(2)創(chuàng)傷性髖股撞擊征的計(jì)算機(jī)模擬和影像學(xué)測(cè)量發(fā)現(xiàn)：①TileB2型旋轉(zhuǎn)不穩(wěn)定性骨盆骨折在導(dǎo)致髖臼內(nèi)旋時(shí),會(huì)使髖關(guān)節(jié)后方過度覆蓋,是造成FAI的危險(xiǎn)因素；②TileB2型骨盆骨折導(dǎo)致髖股撞擊征的發(fā)生與以下兩個(gè)因素有關(guān)：髖臼內(nèi)旋角度和髖關(guān)節(jié)運(yùn)動(dòng)幅度。(3)臨床上應(yīng)用健-患側(cè)外展角差值法測(cè)量骨盆骨折后髖臼旋轉(zhuǎn)角度與實(shí)際情況無顯著差異,其靈敏度較高,能夠較準(zhǔn)確的反映骨盆骨折后髖臼的旋轉(zhuǎn)角度,即實(shí)驗(yàn)CT影像測(cè)量結(jié)果與臨床CT測(cè)讀結(jié)果具有互易性,但臨床應(yīng)用時(shí)應(yīng)注意其適應(yīng)征和操作要求。
[Abstract]:Objective to explore the mechanism of occurrence and development of femoroacetabular impingement (FAI) caused by TileB2 pelvic fracture, and analyze the related factors affecting the occurrence of traumatic hip joint impingement syndrome caused by TileB2 pelvic fracture.
Methods (1) stage 3D model: the application of Mimics software to establish the pelvic and hip joint CT images based on 3D digital model, to simulate the fracture of pelvis and hip joint motion. The basic steps include: first, the acquisition of the image data; the data storage and transmission; the threshold setting, editing the image segmentation; 3D model (. 2) stage of computer simulation and image measurement: the combination mechanism of lateral compression injury of hip joint movement and pelvic fracture of type TileB2 to set the center of rotation of the hip and ilium; simulation of TileB2 pelvic fracture and hip joint of computer movement; through the simulation process of CT reverse image display measurement of hip joint technology, measuring the distance for the combination point of the cortical bone and cartilage by bone and acetabular posterior edge of femoral head and neck (distance from the junction of the femoral neck and hea D to posterior edge of acetabulum, DFPA); the use of SPSS statistical software for statistical analysis of the measurement data. (3) clinical reading method validation stages: Simulation of type TileB2 pelvic fracture, and the application of health - patient abduction angle difference method to measure the validation of computer simulation test and diagnosis of reciprocal reading clinical CT. Basic steps include: setting the center of rotation of the type TileB2 pelvic fracture; simulates pelvic fracture; the health - patient abduction angle difference of pelvic rotation CT imaging measurement; the paired t test statistical analysis.
Results (1) established the pelvic and hip joint 3D model for the study of kinematics simulation and image measurement. The volume of femoral hip 164838mm3, 19853mm2 surface area, consisting of 8884 triangles and 4472 points; iliac bone volume 314552mm3, 59035mm2 surface area, consisting of 40366 triangles and 20245 points (2). The movement of the hip joint dynamic simulation showed that the linear motion of hip movement is not normal, but similar inverse function curve motion model. The slope of the curve decreases, tend to level DFPA tends to be a constant value. When acetabulum internal rotation showed a downward trend in the DFPA dynamic whole curve slope decreases and the curve is gradually decreased. The static simulation showed that the linear correlation of rotation angle DFPA and the acetabulum, regression equation and compute each extension angle. (3) the experimental group and the control group overall measurement results compared no significant difference (t= -1.983, P=0.067), its sensitivity is 80.95%.
Conclusion (1) the application of Mimics software to establish the pelvic and hip joint model 3D model, convenient operation, vivid appearance and accurate data, the distribution rules of one-sided.Mimics software is powerful, can be simulated by 3D model of pelvic fracture and hip joint motion, the simulation process in CT images can display real-time reverse, accurate imaging the measurement of the (2). Computer simulation and imaging of traumatic femoroacetabular impingement measurement was as follows: TileB2 rotary type of unstable pelvic fractures in acetabulum internal rotation, the rear hip over coverage, is a risk factor for the cause of the FAI; the TileB2 pelvic fractures lead to hip impingement syndrome stocks with the following two factors: the acetabulum internal rotation angle and hip joint range of motion. (3) the clinical application of health - patient abduction angle measurement by the difference of pelvis after fracture of acetabulum rotation angle and the actual situation. The sensitivity is high, which can accurately reflect the rotation angle of the acetabulum after pelvic fracture. That is to say, the experimental CT image measurement results are reciprocity with the clinical CT reading results, but the indications and operation requirements should be noted in clinical application.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R683.3;R816.8

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