中国人群下肢正常骨与关节周围解剖数据库的建立

发布时间：2018-03-12 08:40

本文选题：下肢骨骼　切入点：解剖学参数　出处：《第二军医大学》2011年硕士论文　论文类型：学位论文

【摘要】：【研究背景】目前,国外骨科内固定材料是根据西方人正常骨与关节建立的解剖数据库设计的。因我国尚未建立中国人群下肢的正常骨与关节周围解剖数据库,国内骨科器材生产企业生产的下肢不锈钢和钛金属接骨板及螺钉,形式多为仿制国外产品,几何形态不符合国人的骨关节解剖生理特点。为使下肢接骨板和螺钉的设计更加符合国人骨和关节解剖生理特点,有必要建立中国人群的下肢正常骨与关节周围解剖形态学数据库。以减少术中创伤,降低术后内固定断裂、松动、脱落率,增加术后骨折愈合率。为国产下肢接骨板及螺钉的设计、制造、力学分析、临床应用奠定基础。现在,传统的影像学测量方法包括X线平片、CT平扫、MRI平扫及标本中测量。X线平片测量虽然方便、直观,但受测量角度、体位、距离等的影响较大,并且不能进行三维立体解剖学测量,此次研究中利用X线平片测量股骨、胫骨、腓骨长度,股骨、胫骨峡部长度及皮质骨缘切线角度。标本因风干等因素存在,测量误差大,另外骨髓腔部位等数值不易测量。CT及MRI平扫为二维影像,亦不能进行三维立体解剖学测量。美国可视人计划(1989)的出现推动了数字化人与医学图像处理技术的研究,对数字医学的发展有着深远意义,CT三维重建已成为成熟技术,已广泛应用于临床医学。CT三维重建图像具有传统方法不可比拟的优势,能从任意角度和方向观察图像,能够正确标记测量标点减小测量误差。因此,三维重建技术为本研究供新的思路与方法。 SQL Server 2008为超大型数据库软件,并且能通过互联网进行数据的输入及查询,此次研究样本量小、测量项目有限,为今后建立大样本、跨地域及多民族的国人下肢正常骨与关节周围解剖学数据库提供了平台。【研究目的】在平片及CT三维重建影像学图像中,测出下肢骨与关节周围解剖学参数。对数据进行统计学分析,测出每个项目的均数及标准差,并将数据与西方人相比较,发现国人下肢解剖学参数与西方人有统计学差异。同时将测得数据及影像学图像输入SQL Server 2008数据库软件中,备查询及应用。【方法】 1、研究对象及图像采集 (1)150名志愿者来自长期居住华东地区,年龄19-73岁,平均52.8岁,志愿者为正常人或轻度膝关节退变,志愿者下肢均无畸形、无肿瘤、无骨折、无手术史。 (2)Philips DR机对150名志愿者行下肢股骨及胫腓骨全长正侧位平片摄片;TOHSIBA Aquilion C T扫描仪对150志愿者下肢髋、膝、踝关节行CT扫描。 2、CT三维图像重建在个人电子计算机平台上,将髋、膝、踝关节CT平扫Dicom格式输入Mimics 10.01软件中,通过阈值分割、消除噪音、分离结构及光滑图像等步骤对关节周围骨骼CT扫描数据行三维重建,并且可对三维图像进行任意旋转、分割等操作。 3、数据测量 (1)将股骨、胫腓骨全长正侧位平片Dicom格式输入Dicom Explorer软件中直接测出股骨、胫骨、腓骨长度,股骨、胫骨峡部(横截面直径相差不超过1mm)长度,皮质骨缘切线角度; (2)在髋、膝、踝关节CT三维图像中测出关节周围22个解剖学参数,如:股骨颈颈干角、股骨髁宽、胫骨平台宽等。 4、将数据输入数据库软件中将测得数据及影像学图像输入SQL Server 2008数据库软件中,备查询及应用。【结果】 1、选SPSS15.0对测得解剖学参数进行统计学分析,测得平均值及标准差。如:股骨长(大转子中点至股骨外髁距离)382.3±7.8 mm、股骨峡部横径25.0±0.8 mm、股骨颈颈干角129.1±6.5°、股骨髁宽70.8±5.1 mm、胫骨平台宽68.2±4.6 mm。 2、以胫骨平台内翻角、胫骨平台后倾角为例,与西方人解剖形态学参数行t检验,发现两者间有统计学差异。【结论】 1、CT三维重建测量与传统的测量方法比较具有明显优势。三维图像不仅可以清晰、直观地观察,而且可以将各个部位切割、透视及旋转,能够方便测量、减小测量误差,为骨骼的解剖学测量提供了新的技术与方法。 2、SQL Server 2008为超大型数据库软件,不仅存储量大,而且能通过网络传输信息,方便数据输入、查询及应用。由于本研究时间短,收集的样本有限,SQL Server 2008数据库软件为今后建立包括国内不同地域、不同民族的人体骨骼数据库提供了平台。 3、长期临床研究发现,进口内固定器械及其仿制产品不能适合中国人群解剖生理特点,建立中国人的下肢正常骨与关节周围解剖数据库的重要性越来越突出。数据库建立后,通过计算机辅助设计(CAD)及计算机辅助制造(CAM)制造出更加适合国人生理结构的接骨板和螺钉。另一方面,可以辅助手术治疗、辅助临床教学,并且能进一步行下肢骨骼生物力学分析。
[Abstract]:[research background]
At present, foreign department of orthopedics fixation material is based on the normal anatomy of the bone and joint of Westerners to establish database design. Because of the surrounding normal bone and joint China has not yet established a China population lower extremity anatomy database, lower extremity stainless steel and titanium metal plates and bolts domestic Department of orthopedics equipment production enterprises and production, mostly in the form of imitation of foreign products, geometry not in conformity with the anatomical and physiological characteristics of bone and joint of the people. In order to make the design of lower limb bone plate and screw accords with the physiological characteristics of bone and joint anatomy of lower extremity, normal bone and joint around the need to establish China population morphology database. In order to reduce intraoperative trauma, reduce postoperative internal fixation of fracture, loosening, expulsion rate. Increase the postoperative healing rate. Analysis of domestic design, lower limb bone plate and screw manufacturing, mechanical, lay the foundation for clinical application.
Now, the traditional measuring methods including X-ray imaging, CT scan, MRI scan and measurement samples. X Xianping measurement is convenient, intuitive, but by measuring angle, position, influence distance is larger, and not three-dimensional images, X-ray film measurement using the femur in the study the length of tibia, fibula, femur, tibia length and isthmus cortical bone cutting edge angle. Because of factors such as air dried samples, measurement error, numerical in marrow cavity position is not easy to measure.CT and MRI scan two-dimensional images, they are not three-dimensional anatomical measurement.
American visible human project (1989) appears to promote the study of medical image processing and digital technology, has far-reaching significance to the development of digital medicine, CT three-dimensional reconstruction has become a mature technology, has been widely used in clinical medicine.CT 3D reconstruction image has the incomparable advantage of traditional methods, and can observe the image from the direction of any angle can reduce the measurement error of measuring mark correctly labeled. Therefore, 3D reconstruction technology as a new idea and method for this study.
SQL Server 2008 is a very large database software, and through the Internet for data input and query, the small sample size, measurement project Co., for the future establishment of a large sample of Chinese people, the normal limb bone and joint anatomy around database cross regional and multi nationalities provides a platform.
[purpose]
In the flat image 3D reconstruction and CT imaging, measure the lower limb bone and joint surrounding anatomical parameters. The data were statistically analyzed and measured each item of mean and standard deviation and the data compared with westerners, Chinese people found lower extremity anatomy parameters and Westerners have statistical difference. At the same time the measured data and the images are inputted into the SQL Server 2008 database software, the preparation and application of the query.
[method]
1, research object and image acquisition
(1) 150 volunteers came from East China, aged 19-73 years, with an average age of 52.8 years. Volunteers were normal or mild knee degeneration. Volunteers had no deformity in their lower limbs, no tumors, no fractures and no operative history.
(2) Philips DR machine was used for 150 volunteers to perform the anteroposterior lateral radiograph of the femur and tibia and fibula. The TOHSIBA Aquilion C T scanner performed CT scan on 150 volunteers' lower extremities, knees and ankles.
2, CT 3D image reconstruction
In the personal computer platform, the hip, knee, ankle joint CT scan Dicom format into Mimics 10.01 software, the elimination of noise by threshold segmentation, separation, structure and smooth image steps of bone around the joint CT scan data for 3D reconstruction, and the three-dimensional image of arbitrary rotation, segmentation and other operations.
3, data measurement
(1) direct femur, tibia, fibula length, femur and tibial isthmus (cross section diameter no more than 1mm) length and cortical bone edge tangent angle were directly input into Dicom, Dicom and Explorer format of femur, tibia and fibula.
(2) 22 anatomical parameters around the joint were detected in the CT three-dimensional images of the hip, knee, and ankle joint, such as the dry angle of the neck and neck of the femur, the width of the femoral condyle, the width of the tibial plateau and so on.
4, input the data into the database software
The data and image images are input into the SQL Server 2008 database software to prepare the query and application.
[results]
1, SPSS15.0 statistical analysis of the measured anatomic parameters, measured the average value and standard deviation. Such as: the femur length (greater trochanter midpoint to the femoral condyle distance) 382.3 + 7.8 mm, the isthmus diameter of 25 + 0.8 mm, femoral neck shaft angle of 129.1 plus or minus 6.5 degrees, the femoral condyle width 70.8 + 5.1 mm, tibial plateau width of 68.2 + 4.6 mm.
2, with the tibial plateau angle and the tibial plateau tilt angle as an example, the t test with the anatomical morphological parameters of the Westerners found that there was a statistical difference between the two.
[Conclusion]
1, compared with the traditional method of measuring 3D CT reconstruction has obvious advantages. The 3D image can not only clear, direct observation, but also to various parts of the cutting, perspective and rotation, can reduce the measuring error, convenient measurement, provides a new technology and method for the measurement of bone anatomy.
2, SQL Server 2008 is a very large database software, not only a large amount of storage and transmission through the network information, convenient data input, query and application. Because the study time is short, the collection of samples is limited, SQL Server 2008 database software for the future establishment of domestic different regions, different ethnic groups of the human skeleton database provides platform.
3, long-term clinical studies found that the internal fixation devices and imported generic products are not suitable for Chinese anatomical and physiological characteristics, the importance of establishing the normal limb bone and periarticular Chinese anatomical database is becoming more and more prominent. After the establishment of the database, the computer aided design (CAD) and computer aided manufacturing (CAM) to create a more suitable plate and screw in human physiological structure. On the other hand, can be assisted surgical treatment, clinical teaching, and can further lower limb bone biomechanical analysis.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：TP311.13;R322.7

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