【摘要】：目的： 髖關(guān)節(jié)撞擊綜合征(femoroacetabular impingement, FAI)作為髖關(guān)節(jié)退行性骨關(guān)節(jié)炎的一種病因已經(jīng)得到公認(rèn),在多排螺旋CT越來越廣泛使用的今天,如何更好利用多排螺旋CT診斷FAI仍未有公認(rèn)的標(biāo)準(zhǔn)。本研究以國內(nèi)外現(xiàn)有研究為基礎(chǔ),重點(diǎn)分析多排螺旋CT在FAI診斷中的應(yīng)用及臨床意義,探討利用多排螺旋CT平掃及后處理重建方法,了解髖關(guān)節(jié)撞擊綜合征解剖學(xué)及骨質(zhì)異常,分析討論不同后處理方式對(duì)FAI診斷的價(jià)值,并對(duì)FAI進(jìn)行股骨頭頸聯(lián)合處α角、髖臼后傾形態(tài)學(xué)指標(biāo)赤道邊緣角EE角(Equatorial-edge angle)測量分析,旨在探討多排螺旋CT檢查中不同分型FAI的形態(tài)學(xué)指標(biāo)在髖關(guān)節(jié)撞擊綜合征中的應(yīng)用價(jià)值。此外,對(duì)FAI患者進(jìn)行臨床資料收集,對(duì)臨床相關(guān)因素進(jìn)行總結(jié)和分析,探討FAI病因及臨床因素對(duì)FAI疾病發(fā)生發(fā)展的影響。 材料與方法： 1.臨床資料 搜集2010年1月至2012年5月髖關(guān)節(jié)疾患病人2475例,篩選出59例作為FAI組,所有患者均經(jīng)臨床檢查髖關(guān)節(jié)撞擊試驗(yàn)陽性,排除其他因素所致髖部、臀部或腹股溝疼痛,記錄臨床詳細(xì)病史及體征。另選取20例因非股骨近端病變、無髖關(guān)節(jié)撞擊綜合征癥狀而接受下腹或雙髖CT掃描的成年患者的CT容積數(shù)據(jù)作為對(duì)照組進(jìn)行對(duì)比研究。 2.檢查方法 FAI組及對(duì)照組均進(jìn)行東芝AquillionCX64排螺旋CT掃描獲取容積數(shù)據(jù),再利用Aquarius影像工作站進(jìn)行后處理,利用多種重建方法進(jìn)行處理和觀察。掃描采用仰臥位,患者身體中軸線與掃描床軸線平行,雙下肢保持髕骨位置正中朝上 對(duì)篩選出的59例FAI患者進(jìn)行髖關(guān)節(jié)撞擊試驗(yàn),查閱病人所有臨床病歷,并補(bǔ)充詢問病史,記錄病人性別、年齡、一般狀態(tài)、既往史、發(fā)病誘因、運(yùn)動(dòng)習(xí)慣等臨床資料。 3.圖像分析 由兩位高資歷影像科醫(yī)師和兩位初級(jí)影像醫(yī)師對(duì)FAI組的CT圖像進(jìn)行分析,得到統(tǒng)一意見,記錄每個(gè)髖關(guān)節(jié)的解剖學(xué)異常征象,包括股骨頭形態(tài)異常、頭頸聯(lián)合處異常、髖臼異常以及骨質(zhì)硬化、關(guān)節(jié)面損傷、軟骨下囊變、股骨頸疝窩等。選取股骨頭頸聯(lián)合處α角及髖臼EE角作為測量指標(biāo),正常對(duì)照組與FAI組均進(jìn)行測量,由上述四位影像科醫(yī)師測量,結(jié)果取四者平均值。 4.臨床資料分析 由一名高年資醫(yī)師及一名初級(jí)醫(yī)師對(duì)FAI患者進(jìn)行檢查,確定髖關(guān)節(jié)試驗(yàn)為陽性,并對(duì)臨床病史、癥狀及體征進(jìn)行檢查和確認(rèn),得出統(tǒng)一結(jié)論并記錄；分析FAI患者發(fā)病的年齡、性別特點(diǎn),總結(jié)臨床發(fā)病誘因及統(tǒng)計(jì)癥狀部位、程度和特點(diǎn),總結(jié)FAI發(fā)病的臨床因素。 5.統(tǒng)計(jì)學(xué)方法 采用SPSS13.0統(tǒng)計(jì)學(xué)軟件,計(jì)量資料數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,兩組樣本的比較采用兩獨(dú)立樣本t檢驗(yàn)進(jìn)行；3組以上樣本的數(shù)據(jù)比較采用單向方差分析(One-Way ANOVA),多重比較采用LSD法；率的比較采取Pearson卡方檢驗(yàn)分析,多組計(jì)數(shù)資料的比較采取非參數(shù)檢驗(yàn)方法中的Kruskal-Wallis H檢驗(yàn),雙側(cè)檢驗(yàn)P＜0.05時(shí),認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： FAI分為凸輪型、鉗型、混合型,每型均存在不同程度解剖學(xué)異常及骨性異常征象；凸輪型FAI的解剖異常以股骨近端畸形、頭頸間凹陷不足為主,鉗型FAI的解剖異常以髖臼異常為主,包括髖臼后傾、深髖臼、前方或側(cè)方髖臼的過度覆蓋、髖臼的前突等；而混合型FAI的解剖異常可以同時(shí)兼有凸輪型、鉗型的解剖異常；多排螺旋CT能很好顯示關(guān)節(jié)周圍骨質(zhì)硬化、關(guān)節(jié)面損傷、軟骨下囊變、股骨頸疝窩等異常骨質(zhì)改變。對(duì)照組α角為41.826°±1.862°,FAI組為66.548°±9.169°,差異具有統(tǒng)計(jì)學(xué)意義(t=-14.903,P=0.000)；多重比較顯示FAI組中以凸輪型的α角最大(71.851°±5.696°),鉗型的α角最小(48.889°±3.364°全部P＜0.05)多重比較分析EE角顯示除混合型FAI(16.729°±3.068°)和鉗型FAI(16.386°±1.211°)間、FAI凸輪型(21.550°2.096°)與對(duì)照組(21.845°±2.814°)間EE角差異不具有統(tǒng)計(jì)學(xué)意義外(分別P=0.3234,P=-0.,7326),其余兩兩間EE角比較差異均具有顯著統(tǒng)計(jì)學(xué)意義(全部P＜0.05) 統(tǒng)計(jì)分析顯示20-40歲年齡段FAI發(fā)病患者最多(占總數(shù)75%),FAI組與對(duì)照組兩組間患者性別無統(tǒng)計(jì)學(xué)差異,FAI組中凸輪型、鉗型、混合型之間男女性別無統(tǒng)計(jì)學(xué)差異。本組59例FAI患者中,15例有大量或大幅度的髖部運(yùn)動(dòng)史,占25.4%；12例患者有直系親屬出現(xiàn)類似髖部癥狀,占20.3%。29例疼痛部位為髖部,占49.2%；15例以腹股溝疼痛為癥狀,占25.4%；12例以臀部疼痛為癥狀,占20.3%,3例以腰骶部疼痛為癥狀,占5.1%。 結(jié)論： 股骨近端和／或髖臼解剖結(jié)構(gòu)的異常是FAI發(fā)病的重要因素,其原理認(rèn)為異常的解剖結(jié)構(gòu)減少了股骨頸和髖臼之間屈曲運(yùn)動(dòng)終末期的空間,導(dǎo)致髖臼與股骨頸產(chǎn)生異常碰撞,從而損傷髖臼盂唇及關(guān)節(jié)軟骨,引起骨關(guān)節(jié)炎及關(guān)節(jié)退變。凸輪型FAI的解剖異常以股骨近端畸形為主,鉗型FAI以髖臼解剖異常為主,FAI大部分情況是這兩種機(jī)制的復(fù)合體,即為混合型。FAI診斷的形態(tài)學(xué)指標(biāo)尚未有統(tǒng)一標(biāo)準(zhǔn),α角是目前較公認(rèn)的股骨頭頸聯(lián)合處形態(tài)異常的客觀評(píng)價(jià)指標(biāo),利用多排螺旋CT經(jīng)股骨頸斜軸位重建測量α角是角理想的測量方法,本組研究結(jié)果凸輪型FAI的α角最小為62.48°,α角診斷FAI的具體界定值尚待商榷。EE角是評(píng)價(jià)髖臼后傾的一個(gè)客觀指標(biāo),同時(shí)也可以評(píng)估髖臼對(duì)股骨頭覆蓋程度,可以為診斷鉗型及混合型FAI提供參考,本組研究中鉗型EE角為16.386°±2.310°、混合型為15.729°±3.068°；目前EE角在FAI中還沒有作為一個(gè)公認(rèn)的測量指標(biāo)應(yīng)用在診斷工作中,測量量平面及測量方法仍存在分歧。 多排螺旋CT容積數(shù)據(jù)的多種重建方式,可以更加清楚的顯示病變的關(guān)節(jié)及骨質(zhì)內(nèi)部的改變。利用多排螺旋CT的容積數(shù)據(jù)進(jìn)行多種后處理,其中MPR、VR及SSD技術(shù)是最常用的后處理方式,對(duì)解剖學(xué)異常及細(xì)微骨質(zhì)改變顯示有獨(dú)特優(yōu)勢,是診斷FAI較理想的方法。 診斷FAI須建立在影像學(xué)與臨床密切結(jié)合的基礎(chǔ)上,特別是與年齡不相符并且無陳舊性創(chuàng)傷病史的慢性髖關(guān)節(jié)區(qū)域疼痛、髖關(guān)節(jié)退行性變,如果影像學(xué)檢查提示形態(tài)學(xué)存在FAI的風(fēng)險(xiǎn)因素,均應(yīng)將FAI列入診斷范圍。
[Abstract]:Purpose: The cause of hip joint impact syndrome (FAI) as a cause of the degenerative osteoarthritis of the hip has been recognized, and today, how to better utilize the multi-slice spiral CT to diagnose FAI has not yet been accepted. To study the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI, this study is based on the existing research at home and abroad, and discusses the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI. In this paper, the value of different post-treatment methods for FAI diagnosis was analyzed, and FAI was used to measure the angle of the joint of the head and neck of the femoral head. The purpose of this study is to explore the application of different types of FAI in multiple-slice spiral CT examination in the hip-impact syndrome. Value. In addition, the clinical data collection of FAI patients is performed, and the clinical-related factors are summarized and analyzed, and the causes of FAI and the shadow of the development of FAI diseases are discussed. in response to that material The method is as follows: 1. The clinical data collected 2475 cases of hip joint disease from January 2010 to May 2012, and 59 cases were selected as FAI group. All patients were tested positive by clinical examination of hip joint, and the hip and hip caused by other factors were excluded. Department or groin pain, record clinical Detailed medical history and signs.20 cases of adult patients receiving lower or double-hip CT scans for non-femoral proximal lesions and without hip-impingement syndrome were selected as controls group comparison and research 2. The method FAI and the control group were examined for volume data by the Toshiba Aquarion CX64-row spiral CT scan, and then the Aquarius image work station was used for post-treatment and a variety of methods were used. The reconstruction method is used for the treatment and observation. The scanning adopts the supine position, the central axis of the patient's body is parallel to the axis of the scanning bed, A total of 59 FAI patients screened out of the position of the lower limb in the position of the patella were subjected to hip impact test, and all the clinical medical records of the patient were consulted and the inquiry was supplemented. Ask for medical history, record patient's sex, age, general status, past history, hair the cause of the disease, the movement 3. The analysis of the CT images of the FAI group by two high-qualified and two primary medical practitioners in the image analysis to obtain a unified view to record the anatomical abnormalities of each hip joint. Including abnormal head shape, abnormal head and neck joint, acetabular abnormality, and bone hardening and closing. The joint of the head and neck of the femoral head and the angle of the acetabular EE were selected as the measurement index, and the normal control group and the FAI group were measured. Physician's measurement of the bit image department 4. The results are as follows:4. The clinical data analysis is performed by a high-year-age physician and a primary physician to the FAI patient, and the hip joint test is determined to be positive, and the clinical history, symptoms and signs are checked and confirmed to obtain a unified conclusion. The age and sex characteristics of the patients with FAI were analyzed and the causes of the clinical attack and the statistical symptoms were summarized. Location, degree, and The clinical factors of the incidence of FAI were summarized.5. The statistical method used the SPSS13.0 statistical software and the standard deviation (x% s) of the mean number of the data used for the measurement data. The comparison of the two groups was carried out by two independent samples t. The number of the above three samples One-Way ANOVA was used to compare the multiple comparisons with the LSD method; the Pearson chi-square test was used for the comparison of the rates, and the comparison of the multiple sets of counting data took the Kruskal-Wallis H in the non-quantitative test method. inspection, The results showed that FAI was divided into cam type, clamp type and mixed type, and there were different degree of anatomical and abnormal signs in each type. The anatomical abnormality of the cam type FAI was caused by the proximal femur. The shape and the depression of the head and neck are not the main, and the anatomic abnormality of the clamp type FAI is mainly due to the abnormal acetabulum, including the over-covering of the acetabulum, the deep acetabulum, the anterior or lateral acetabulum, the anterior projection of the acetabulum, and the like; and the anatomical abnormality of the mixed type FAI can both have both the cam type and the forceps-type anatomic abnormality; and the multiple rows The spiral CT can well show the periphery of the joint. The mean angle of the control group was 41.826 擄 and 1.862 擄, and the difference of the control group was 66.548 擄 and 9.169 擄, and the difference had statistical significance (t =-14.903, P = 0.000), and the multiple comparison showed that F In the AI group, the maximum angle of the cam type (71.851 擄 and 5.696 擄), the minimum angle of the clamp type (48.889 擄 and 3.364 擄 all P <0.05), and the multiple comparison and analysis of the EE angle showed that the FAI cam type (21.550 擄 2.096 擄) and the control group (21.845 擄 and 2.81 擄) were compared with the control group (21.45 擄 and 2.096 擄) and the clamp type FAI (16.386 擄 and 1.211 擄), and the FAI cam type (21.550 擄 2.096 擄) and the control group (21.845 擄 and 2.81 擄) 4 擄) E The difference of E-angle was not statistically significant (P = 0.3234, P =-0,7326, respectively), and the rest The difference of the two EE angles was statistically significant (all P <0.05). The statistical analysis showed that the maximum number of patients with FAI in the age group of 20 to 40 years (75% of the total), FA There was no statistical difference between the group I and the control group. There were no significant differences in the male and female sex between the cam type, the clamp type and the mixed type in the FAI group. Among the 59 cases of FAI,15 had a large or large number of hip motion history, accounting for 25.4%, and 12 patients had a direct relative to the hip symptom, accounting for 20.3%. The pain point in 29 cases was hip, accounting for 49.2%; 15 cases of groin pain, 25.4%;12 hips Department pain Conclusion: The abnormal structure of the proximal femur and/ or the acetabulum is an important factor in the pathogenesis of FAI. Reduced space in the end of flexion between the femoral neck and the acetabulum, resulting in the acetabular component There was an abnormal impact on the femoral neck, which damaged the labral and articular cartilage of the acetabulum, resulting in osteoarthritis and joint degeneration. The anatomic abnormality of the cam-type FAI was dominated by the proximal femur, and the clamp-type FA I was the main body of the acetabulum, and most of the FAI was the complex of the two mechanisms, which is the mixed type. The morphological index of the FAI diagnosis has not been unified, and the angle of incidence is the objective of the abnormal morphology of the joint of the femoral head at present. The evaluation index, using the multi-slice spiral CT to reconstruct the angle of the femoral neck through the oblique axis of the femoral neck, is an ideal method for measuring the angle, and the results of this study are convex. The minimum angle of the wheel-type FAI is 62.48 擄, and the specific definition of the angle-angle diagnostic FAI is still to be discussed. The EE angle is an objective index to evaluate the posterior gradient of the acetabulum. At the same time, it is also possible to evaluate the extent of the acetabulum to the head of the femoral head, which can be used as a reference for the diagnosis of the clamp type and the mixed type FAI. The angle is 16.386 擄 and 2.310 擄, and the mixed type is 15.729 擄 and 3.068 擄; the current EE angle is not yet available in FAI As a well-established measurement index, in the diagnosis, there are still differences in the measurement plane and the measuring method. The multi-slice spiral CT volume data can be used for many post-processing, in which MPR, VR and SSD technology are the most commonly used The diagnosis of FAI must be based on the close combination of the image and the clinical, in particular with the age that is not consistent with the age and the history of no old trauma. Regional pain in the area of the hip, the hip is backed out
【學(xué)位授予單位】：廣州中醫(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)】：R274.9;R816.8

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本文編號(hào)：2508193