本文選題：CT + 三維重建　； 參考：《浙江中醫(yī)藥大學(xué)》2013年碩士論文

【摘要】：目的：依據(jù)三維CT圖像數(shù)據(jù),在股骨頭三維CT診斷分析系統(tǒng)中重構(gòu)出三維股骨頭壞死模型,直觀化確定壞死的部位,測(cè)出壞死病灶的體積并與股骨頭壞死大體標(biāo)本的體積比較,探討其準(zhǔn)確性及臨床實(shí)際意義。 方法：38例(53髖)股骨頭壞死患者,男26例,女12例,平均年齡38.5歲(32-58歲)。激素性壞死17例(28髖),酒精性壞死14例(17髖),特發(fā)性壞死4例((4髖),創(chuàng)傷性壞死3例(4髖)。ARCO分期：Ⅱ期11髖, Ⅲ期30髖,Ⅳ期12髖。所有患者每6個(gè)月進(jìn)行一次三維CT檢查。在行全髖關(guān)節(jié)置換術(shù)術(shù)前再次進(jìn)行三維CT掃描,獲得髖關(guān)節(jié)三維CT圖像的DICOM格式數(shù)據(jù)。利用白行研發(fā)的股骨頭壞死測(cè)量軟件將圖像導(dǎo)入,提取出股骨頭及其壞死區(qū)域的輪廓。并直接讀取股骨頭及其壞死組織區(qū)域的體積及兩者之間的百分比、壞死占各個(gè)象限的百分比。臨床隨訪以股骨頭塌陷作為觀察的終點(diǎn),對(duì)未塌陷的患者至少觀察24個(gè)月。使用采用SPSS17.0統(tǒng)計(jì)軟件對(duì)重建股骨頭與真實(shí)股骨頭及壞死體積的差異進(jìn)行t檢驗(yàn),選擇直線相關(guān)和回歸分析分析各參數(shù)與塌陷的相關(guān)性。對(duì)行全骸關(guān)節(jié)置換術(shù)的患者,將術(shù)后取出的股骨頭進(jìn)行大體測(cè)量。使用移水法測(cè)出大體股骨頭及其壞死病灶的體積,與計(jì)算機(jī)所得結(jié)果相比較,進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：重構(gòu)的三維股骨頭模型上可見股骨頭壞死區(qū)域多位于股骨頭的外上方,與大體股骨頭壞死病灶的位置符合。42髖通過軟件測(cè)得整個(gè)股骨頭的體積為48.03±4.82cm3(范圍為36.42-61.38cm3),壞死病灶的體積為20.63±6.54cm3(范圍為10.52-38.94cm3)。股骨頭壞死病灶的體積與整個(gè)股骨頭的體積比為42.6%±11.78。大體測(cè)得整個(gè)股骨頭的平均體積為(48.66±4.42)cm3,股骨頭壞死區(qū)域的平均體積為(20.7±5.5)cm3(范圍為10～39cm3)。股骨頭壞死區(qū)域的體積與整個(gè)股骨頭的體積比為42.5%±11.87。實(shí)體測(cè)量的體積值比軟件測(cè)量的體積值稍略大,兩者相比整個(gè)股骨頭體積約大1.23%,股骨頭壞死區(qū)域體積約大1.97%。兩者測(cè)量的體積差,整個(gè)股骨頭的為0.43±0.7cm3,在統(tǒng)計(jì)學(xué)上無顯著性差別(配對(duì)t=-1.515,P0.05)；股骨頭壞死病灶的體積差為0.97±0.45cm3,在統(tǒng)計(jì)學(xué)上也無顯著性差別(配對(duì)t=-1.523,P0.05)。隨訪的38例(53髖)中有42髖發(fā)生了塌陷,平均股骨頭壞死體積比為35.8%±12.5,未塌陷的11髖,平均股骨頭壞死體積比為16.35%±5.42；塌陷的股骨頭中,t1象限壞死體積占整個(gè)股骨頭壞死體積的比例為10.3%±7.9,t2象限為11.3%±6.8,t3象限為6.3%±7.9,t4象限為22.3%±8.7,t5象限為23.5%±11.7,t6象限為12.3%±8.1,t7象限為3.6%±2.6, t8象限為4.1%±5.3,t9象限為2.7.%±6.9, t10象限為1.1%±2.4, t11象限為1.3%±3.3, t12象限為1.1%±1.6；在未塌陷的股骨頭中,t1象限壞死體積占整個(gè)股骨頭壞死體積的比例為27.3%±10.8,t2象限為23.5%±11.7,t3象限為13.6%±7.9, t4象限為11.3%±6.9,t5象限為12.3.%±7.8,t6象限為6.3%±7.9, t7象限為3.6%±2.6, t8象限為4.1%±5.3,t9象限為2.7.%±6.9, t10象限為0.1%±2.4, tll象限為0.3%±3.3,t12象限為0.1%±1.6。相關(guān)回歸分析結(jié)果表明,股骨頭壞死體積比(v01)與塌陷密切相關(guān),p0.05,壞死灶在t4,t5及t6象限的分布比例也與股骨頭塌陷密切相關(guān),p0.05。當(dāng)壞死病灶體積大于35%時(shí),股骨頭壞死的塌陷率高達(dá)76%以上。 結(jié)論：CT圖像計(jì)算機(jī)三維重建可以精確地重構(gòu)出股骨頭壞死的三維模型,可以幫助臨床骨科醫(yī)師直觀、立體化地理解股骨頭壞死病灶的形狀和位置。能夠準(zhǔn)確地計(jì)算壞死病灶的體積,其結(jié)果可信,與大體測(cè)量相符合。股骨頭壞死病灶體積的大小、壞死體積的分布位置與股骨頭塌陷的危險(xiǎn)性密切相關(guān)�；貧w分析結(jié)果表明股骨頭壞死體積比在預(yù)測(cè)股骨頭塌陷中起重要作用,當(dāng)壞死體積比大于35%,即有塌陷的危險(xiǎn)。股骨頭壞死的分布在小范圍壞死中對(duì)預(yù)測(cè)塌陷起重要作用,當(dāng)壞死體積比小于20%,如果壞死分布在第t4-t6象限(股骨頭前外上方),股骨頭有塌陷的潛在危險(xiǎn)。
[Abstract]:Objective: according to the three-dimensional CT image data, three-dimensional femoral head necrosis model was reconstructed in the three-dimensional CT diagnosis and analysis system of femoral head, and the necrotic site was determined intuitively, the volume of the necrotic focus was measured and compared with the volume of the gross necrosis of the femoral head, the accuracy and the practical significance of the bed were discussed.
Methods: 38 cases (53 hips) with avascular necrosis of the femoral head, 26 men and 12 women, with an average age of 38.5 years (32-58 years), 17 cases of steroid necrosis (28 hips), 14 cases of alcoholic necrosis (17 hips), 4 idiopathic necrosis (4 hips) and.ARCO staging of traumatic necrosis (HIPS): stage II hip, stage III hip, and IV hip. All patients performed a three dimensional CT examination every month. Three dimensional CT scan was performed again before total hip replacement to obtain the DICOM format data of the 3D CT image of the hip joint. The image was introduced into the femoral head and its necrotic region by using the femoral head necrosis measurement software developed in white. The percentage of each quadrant, necrosis was used as the end point of the observation of the femoral head collapse, and at least 24 months were observed in the patients without the collapse. The SPSS17.0 statistical software was used to test the difference between the femoral head and the real femoral head and the volume of the necrosis, and the parameters and the collapse were analyzed by linear correlation and regression analysis. The total femoral head and its necrotic focus were measured by the method of water transfer, and the results were compared with the results of the computer.
Results: the femoral head necrosis area of the reconstructed femoral head was found in the upper part of the femoral head, and the size of the whole femoral head was 48.03 + 4.82cm3 (range 36.42-61.38cm3), and the volume of the necrotic foci was 20.63 + 6.54cm3 (range 10.52-38.94cm3). The volume ratio of the necrosis of the femoral head to the whole femoral head is 42.6% + 11.78., and the average volume of the whole femoral head is (48.66 + 4.42) cm3, the average volume of the necrosis area of the femoral head is (20.7 + 5.5) cm3 (range 10 to 39cm3). The volume ratio of the necrosis area of the femoral head with the whole femoral head is 42.5% + 11.87. solid measurements. The volume value of the volume is slightly larger than that measured by the software. The volume of the femoral head volume is about 1.23% and the volume of the femoral head necrosis area is about 1.97%.. The volume of the femoral head is about 0.43 + 0.7cm3, and there is no significant difference in Statistics (paired t=-1.515, P0.05); the volume difference of the necrosis of the femoral head is 0.97 + 0.45. Cm3, there was no statistically significant difference (paired t=-1.523, P0.05). In 38 cases (53 hips), 42 of the hips were collapsed, the average necrosis volume ratio of the femoral head was 35.8% + 12.5, the unsubsided 11 hips, the mean femoral head necrosis volume ratio was 16.35% + 5.42, and the T1 quadrant necrosis volume accounted for the whole femoral head necrosis volume in the collapsed femur head. The ratio of the T2 quadrant is 11.3% + 6.8, the T3 quadrant is 6.3% + 7.9, the T4 quadrant is 22.3% + 8.7, the T5 quadrant is 23.5% + 11.7, the T6 quadrant is 12.3% + 8.1, the T7 quadrant is 3.6% + 2.6, the T8 quadrant is + 7.9, the T9 quadrant is 2.7.% +. The proportion of the necrotic volume of the whole femoral head is 27.3% + 10.8, the T2 quadrant is 23.5% + 11.7, the T3 quadrant is 13.6% + 7.9, the T4 quadrant is 11.3% + 6.9, the T5 quadrant is 12.3.% + 7.8, the T6 quadrant is 6.3% +, and the T7 quadrant is 3.6% + 2.6, the T8 quadrant is 6.9, and the T9 quadrant is 2.7.% +. The results of 0.1% + 1.6. correlation regression analysis showed that the volume ratio of necrosis of the femoral head (V01) was closely related to the collapse. P0.05, the distribution ratio of the necrotic foci in T4, T5 and T6 quadrants was closely related to the collapse of the femoral head, and the collapse rate of the necrosis of the femoral head was over 76% when the necrotic focus volume was greater than 35% in p0.05..
Conclusion: the three-dimensional reconstruction of the CT image can accurately reconstruct the three-dimensional model of the necrosis of the femoral head. It can help the clinical department of orthopedics doctors to intuitively understand the shape and position of the necrosis of the femoral head, and can accurately calculate the volume of the necrotic focus. The results are reliable, and the volume of the necrosis of the femoral head is in accordance with the gross measurement. The size of the necrotic volume is closely related to the risk of the collapse of the femoral head. Regression analysis shows that the volume ratio of the necrosis of the femoral head plays an important role in predicting the collapse of the femoral head, when the necrotic volume ratio is greater than 35%, that is, the risk of collapse. If the necrosis volume ratio is less than 20%, if the necrosis is distributed in the T4-T6 quadrant (above and outside the femoral head), the femoral head will have potential risk of collapse.

【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.8

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