计算机处理距骨骨软骨损伤MRI图像测定坏死体积及体外冲击波治疗的疗效分析

发布时间：2018-01-06 22:33

  本文关键词：计算机处理距骨骨软骨损伤MRI图像测定坏死体积及体外冲击波治疗的疗效分析　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 核磁共振成像 三维模型 ESWT OLT AOFAS评分

【摘要】：目的:依据T1加权相矢状位MRI图像数据,计算机上重构出体外冲击波治疗前后距骨骨软骨损伤(OLT)的三维模型,直观化明确软骨损伤部位,并计算得出软骨损伤的体积,比较体外冲击波治疗OLT的前后变化,探讨其疗效及临床应用意义。方法:24例(30踝)早中期OLT患者,男16例,女8例,平均年龄37.5岁(18~57岁)。病程4~13个月,平均6.5个月。所有患者均有一侧或双侧踝关节扭伤病史,左侧12例,右侧18例。Hepple分期[1]:I期7踝,II期12踝,III期11踝。患者均有不同程度的踝关节肿胀、疼痛,伴有一定程度跛行,负重或活动后疼痛加重,踝关节活动僵硬伴有功能障碍。踝关节X线片仅有局部骨密度影增高或无明显变化,尚未出现距骨的塌陷。一侧或双侧踝关节MRI T1加权相上距骨表面显示斑片状低信号区。有时T1加权相可见线样状低信号,T2加权相显示低信号内出现高信号线,即“双线征”。其中大部分患者曾经接受过保守治疗,包括制动、理疗、口服药物、局部类固醇注射等,但治疗后效果不佳。每位患者体外冲击波治疗前及治疗3个疗程后进行一侧或双侧踝关节MRI检查,薄层厚度(Thick)为2mm,踝关节MRI矢状位T1加权相图像以DICOM格式数据保存。利用Mimics软件的图像处理功能形成预处理文件,运用Adobe Photoshop图像编辑软件分别描绘出距骨区域及其骨软骨损伤区域的范围。依靠Magics实体造型软件重构出相应的骨软骨损伤部位及距骨的三维立体模型,采用体积测算模块功能计算并读取距骨及骨软骨损伤区域的体积,依据相应的公式计算得到距骨骨软骨损伤区域的百分比。采用骨科发散式ESWT治疗机按疗程进行治疗,按照临床纳入标准及排除标准筛选出的患者,治疗前均进行VAS评分及AOFAS评分。按照OLT患者MRI的Hepple分期结合AOFAS评分标准分为轻度、中度、重度三组。设定ESWT同样的能量参数,对患者进行3个疗程规律的ESWT治疗,疗程间歇期间指导患者进行一定的功能锻炼。3个疗程结束后对患者再次进行VAS评分及A0FAS评分,并根据相应的疗效评分结果,得出ESWT治疗早中期OLT患者的优良率。收集并整理数据,图表观察分布情况,统计学进行数据分析。利用SPSS13.0分析软件对实验最终数据进行统计学分析,结果以均数±标准差表示,并采用配对样本t检验分析。结果:重构的三维距骨模型上可见骨软骨损伤区域位于前外侧穹窿部或后内侧穹窿部。计算机上测得整个距骨的体积、ESWT治疗前骨软骨损伤区域的体积、治疗3个疗程后骨软骨损伤区域的体积。根据相应的疗效评分结果,得出ESWT治疗早中期OLT患者的优良率。其中ESWT治疗轻、中度患者有明显的疗效,对于重度患者缓解急性疼痛症状有较好的作用。3个疗程治疗结束后,VAS评分明显降低,AOFAS评分显著升高,与治疗前对比差异有统计学意义(P0.05)。结论:利用计算机进行MRI图像的三维重建可以重构出OLT三维模型,帮助临床医师直观、精确地观察OLT病灶的形状和位置。能够准确地计算损伤病灶的体积,其结果可信。ESWT可对早中期OLT患者具有干预控制作用,研究表明能够达到延缓及减轻病灶发展的作用,因而ESWT可作为治疗早中期OLT疾病的有效方法之一。
[Abstract]:Objective: Based on the T1 weighted sagittal MRI image data, reconstruct the extracorporeal shock wave before and after the treatment of osteochondral lesions of the talus computer (OLT) of the 3D model, intuitive clear cartilage injury site, and calculated the volume of cartilage injury, comparison of extracorporeal shock wave changes before and after the treatment of OLT, to investigate the clinical significance and its application the curative effect. Methods: 24 cases (30 ankle) early stage OLT patients, 16 were male, 8 were female, the average age of 37.5 years (18~57 years). The duration of 4~13 months, average 6.5 months. All patients had unilateral or bilateral ankle sprain history, 12 cases on the left side, right side 18 cases of stage [1]:.Hepple I 7 II 12 ankle, ankle, ankle. 11 stage III patients had different degree of ankle joint swelling, pain, accompanied by a certain degree of lameness, increased pain or weight-bearing activity after ankle stiffness accompanied by dysfunction. Bone density of ankle radiographs only increased or had no significant change in bureau of the Ministry of, Has not yet appeared talar collapse. Unilateral or bilateral ankle MRI T1 weighted on the talus surface showed patchy low signal area. Sometimes T1 weighted visible line like low signal, T2 weighted phase showed high signal in the low signal, namely "double line sign". Most of these patients had received conservative treatment, including brake, physical therapy, oral medication, local steroid injections, but after treatment ineffective. Each patient in vitro shock wave therapy before and after 3 courses of treatment for unilateral or bilateral ankle joint MRI examination, thin layer thickness (Thick) of 2mm, MRI of ankle sagittal T1 weighted image in DICOM format data. Using Mimics software image processing function to form the preprocessed file, using Adobe Photoshop image editing software are respectively described the scope of talar osteochondral injury area and its area. Relying on Magics solid modeling software constructs corresponding The three-dimensional model of bone and cartilage injury and talus, using the volume measurement module function calculation and read the talus and osteochondral lesions of the volume of the region, on the basis of the corresponding formula percentage of osteochondral lesions of the talus area. The Department of orthopedics divergent ESWT treatment machine according to the course of treatment, according to clinical inclusion criteria and exclusion criteria selected the patients before the treatment, VAS score and AOFAS score. According to OLT MRI of patients with Hepple staging with AOFAS standard for evaluation is divided into mild, moderate and severe three groups. ESWT the same set of energy parameters, ESWT treatment for 3 courses of patients, during the course of intermittent guide patients over certain functional exercise.3 after a course of treatment of patients with VAS score and A0FAS score again, and according to the corresponding clinical score results, that ESWT treatment of early stage OLT patients. The excellent rate of collection And the data and charts to observe the distribution, statistical analysis of data. The statistical analysis of the experimental data using SPSS13.0 analysis software, the mean standard deviation, and using paired samples t test analysis. Results: the three-dimensional model reconstruction on the talus bone cartilage damage area is located in the anterolateral or posterior fornix fornix the inner side of the computer. The measured volume of the talus, ESWT before the treatment of osteochondral lesions of the volume of the region, the volume of bone and cartilage injury region after 3 courses of treatment. The curative effect according to the corresponding score results, obtained ESWT treatment of early stage OLT patients. The excellent rate of ESWT has obvious curative effect in treatment of mild, moderate patients. For patients with severe acute pain relief symptoms over a course of treatment and good effect of.3, VAS score decreased significantly, AOFAS score increased significantly, with statistical difference compared with before treatment Significance (P0.05). Conclusion: three dimensional reconstruction of MRI images by computer can reconstruct the 3D OLT model, help the clinician intuitively, accurately observed the shape and location of lesions. OLT can accurately calculate injury lesion volume, the result has control effect on early stage intervention in patients with OLT can be trusted.ESWT, study shows to delay and reduce the lesion development, so ESWT can be treated as one of the effective methods to early metaphase OLT disease.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.3;R445.2

【共引文献】

中国期刊全文数据库 前6条

1 翟磊;邢更彦;姜川;李冰;赵哲;王旭明;;体外冲击波疗法联合钻孔减压术治疗战士训练后股骨头缺血性坏死的效果观察[J];解放军医学杂志;2008年03期

2 华桂茹;;骨关节炎的物理治疗与康复[J];继续医学教育;2006年30期

3 孙建峰;李红娟;;放射式体外冲击波治疗肘外侧软组织疼痛疗效观察[J];颈腰痛杂志;2012年03期

4 刘洋;王文波;赵哲;于宏伟;李雪松;王洪亮;郜杨;;有限元法分析全髋关节置换术后股骨近端应力变化[J];哈尔滨医科大学学报;2012年05期

5 涂宏亮;唐旭东;;依托芬那酯凝胶治疗运动系统慢性软组织损伤的临床疗效分析[J];华西医学;2014年05期

6 谢卫勇;杨延军;黄刚;邱鑫林;赫明堂;叶伟德;;微创手术与保守治疗踝关节退行性骨关节病的临床观察[J];中国民族民间医药;2015年05期

中国博士学位论文全文数据库 前4条

1 贾晓军;ARCO Ⅲ期股骨头坏死保髋治疗中期疗效评价与力学分析[D];广州中医药大学;2011年

2 邢更彦;体外冲击波疗法促进成骨的基础及相关临床研究[D];第二军医大学;2005年

3 张科强;冲击波诱导人骨髓间充质干细胞向成骨细胞分化的机制[D];吉林大学;2008年

4 鲁超;基于三维有限元动态模拟分析健脾活骨方治疗ARCOⅡ期股骨头坏死的生物力学研究[D];中国中医科学院;2014年

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