【摘要】：目的：通過系統(tǒng)回顧56例成人股骨頭壞死影像學(xué)相關(guān)資料,對日常生活中髖關(guān)節(jié)的應(yīng)力分布及股骨頭的解剖、血供等特點進行分析,分析不同壞死范圍及姿勢下,股骨頭應(yīng)力峰值的大小及分布有無差異,以及其與股骨頭壞死區(qū)的匹配程度,試圖分析驗證兩者之間的相關(guān)性,從股骨頭的應(yīng)力方面有效指導(dǎo)股骨頭壞死的預(yù)防和診治工作。方法：收集2011年9月至2016年3月在我院確診的股骨頭壞死患者的髖關(guān)節(jié)CT影像,按納入標準及排除標準,總計56例(56髖),通過使用Mimics軟件,定位股骨頭壞死區(qū)域、壞死區(qū)中心點、計算出股骨頭壞死面積,將數(shù)據(jù)導(dǎo)入并轉(zhuǎn)換,重建患者髖部三維影像,并模擬出站立位、坐位及行走位這三個姿勢下,分析各種姿勢下應(yīng)力峰值分布區(qū)情況,將所得的數(shù)據(jù)建立數(shù)據(jù)庫,應(yīng)用統(tǒng)計學(xué)方法進行分析。結(jié)果：男性29例,女性27例；平均年齡45歲(18-83歲),股骨頭壞死范圍Ⅰ級7髖,Ⅱ級14髖,Ⅲ級17髖,Ⅳ級18髖。壞死區(qū)分布：股骨頭壞死區(qū)分布位于前柱者30例,位于后柱及頂柱者均為2例,位于頂外柱者22例。股骨頭應(yīng)力峰值的分布分別為：站立位,前柱者27例,位于后柱者2例,頂柱者3例,位于頂外柱者24例；坐位,前柱者20例,位于后柱者3例,頂柱者12例,頂外柱者21例；行走位,前柱者28例,后柱者3例,頂柱者2例,位于頂外柱者23例。股骨頭壞死范圍與不同姿勢下股骨頭應(yīng)力峰值大小(P值=0.025),兩者存在統(tǒng)計學(xué)差異,股骨頭不同壞死范圍與股骨頭應(yīng)力峰值的分布的(P值=0.972)、站立位及行走位,股骨頭壞死區(qū)的分布跟應(yīng)力峰值的分布P值0.05。結(jié)論：不同壞死范圍,股骨頭應(yīng)力峰值的大小不同,壞死范圍越大,應(yīng)力峰值反而越小。且行走位時,應(yīng)力峰值最大,坐位次之,站立位最小。站立位與行走位是股骨頭應(yīng)力峰值分布區(qū)與股骨頭壞死的分布區(qū)基本一致,主要在股骨頭的前柱及頂外柱。
[Abstract]:Objective: to analyze the characteristics of stress distribution, anatomy and blood supply of hip joint in daily life by systematically reviewing the imaging data of 56 cases of adult osteonectasis, and to analyze whether there are differences in the magnitude and distribution of the peak stress of the femoral head under different ranges and postures, and the matching degree between the stress peak value and the necrotic area of the femoral head, so as to try to analyze and verify the correlation between the stress distribution of the hip joint, the anatomy and blood supply of the femoral head, and the matching degree between the two areas. The prevention, diagnosis and treatment of osteonecrosis of femoral head are effectively guided by the stress of femoral head. Methods: the CT images of hip joint were collected from September 2011 to March 2016 in our hospital. According to the inclusion standard and exclusion standard, a total of 56 cases (56 hips) were enrolled. By using Mimics software, the area of avulsion of the head was calculated, the data were introduced and converted, the three-dimensional images of the hip were reconstructed, and the standing position, sitting position and walking position were simulated. The distribution area of stress peak value under various postures is analyzed, and the data are established and analyzed by statistical method. Results: there were 29 males and 27 females with an average age of 45 years (18 鈮，

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