640层动态容积CT对正常人与髌股关节对合不良患者的髌骨运动轨迹的对比性研究

  本文关键词：640层动态容积CT对正常人与髌股关节对合不良患者的髌骨运动轨迹的对比性研究，由笔耕文化传播整理发布。

        本课题分为两部分,第一部分研究640层CT运动成像在正常人髌骨运动轨迹的中的应用价值；第二部分研究640层动态容积CT运动成像对髌股关节对合不良患者的应用价值,并将所得到的数据与第一部分得到的正常人的髌骨运动轨迹进行对比第一部分640层动态容积CT扫描对正常人髌骨运动轨迹的应用价值目的在非负重状态下,采用640层动态容积CT运动扫描成像技术在正常人髌骨运动轨迹的动态连续运动变化中的应用价值,为髌股关节对合不良的病人的诊断,提供一定正常值的参考标准。材料和方法研究对象：前瞻性纳入2013年9月～11月九龙医院共20例正常人,其中男15例,女5例,年龄18～51岁,平均35.95岁,取被检查者双侧膝关节,故为40只膝关节。所有人均用Toshiba Aquilion one640层动态容积CT进行髌骨运动轨迹的连续扫描。两种测量方法：被检查者仰卧于CT检测床上,将两侧膝关节放于测量台上,固定受检者双侧膝关节的内、外上髁,调整2点连线平行于测量台；通过调整体位固定股骨头几何中心和内、外上髁中点的连线平行于测量台,取膝关节全伸位为测量起始点。具体的方法如下：(1)分别于膝关节屈曲角度为30°时,测量髌骨适合角、髌骨外侧角、髌股指数、股骨滑车角及髌骨高度这5组数据的值。(2)640层动态容积CT对40只膝关节行动态容积扫描,全伸位建立3D坐标,坐标原点为髌骨中心点,扫描时间共为13s,我们可以得到膝角为0°～60°时的膝关节的运动轨迹,并分析膝关节稳定性的3D坐标值。结果共计测量40只正常人的膝关节,所得结果如下：1.正常人膝关节的髌股关节稳定性的分级结果为：Ⅰa级4个(10%),Ⅰb级2个(5%),Ⅳa级24个(60%),Ⅳb级10个(25%),Ⅰc、Ⅳc、Ⅱ、Ⅲ级皆为0个。2.随着膝角在0°-10°之间时,髌骨在X轴上轻度向内侧移动,而后随着膝角的变化(20°～60°),髌骨持续不断的向外侧移位；随着膝关节角度的变化(0。-60。),在Y轴(矢状位)上,髌骨持续不断的向下滑行；髌骨在Z轴的运动轨迹,随着膝关节屈曲角度的变化,髌骨滑行的轨迹总体是向后的。初始阶段,髌骨的运动幅度变化不大,随着膝关节角度的变化,其中于50。-60。时,髌骨的滑行幅度达到最大。结论640层动态容积CT不仅可以提供传统的诊断髌股关节稳定性所要的数值,而且能够提供髌骨运动轨迹的的三维坐标值,为临床诊断髌股关节稳定性提供更加全面的资料。第二部分640层动态容积CT扫描对髌股关节对合不良患者的髌骨运动轨迹的应用价值目的：在非负重状态下,运用640层动态容积CT成像技术,讨论髌股关节对合不良病人的髌骨运动轨迹的应用价值,将正常人髌骨运动轨迹与髌股关节对合不良病人的髌骨运动轨迹进行对照分析。材料和方法：收集2013年9月～11月九龙医院髌股关节对合不良的病人20例,男9例,女11例,年龄18～55岁,平均33.55岁,取病人双侧膝关节,共40只膝关节。具体的测量方法及统计学方法与第一部分相同。结果：髌股关节对合不良病人的膝关节共计40只：(1).所得到的40只髌股关节对合不良病人的膝关节稳定性的分级结果为：Ⅰa级9个(22.5%),Ⅰb级25个(62.5%),Ⅰc级3个(7.5%),Ⅲb级2个(5%),Ⅳa级1个(2.5%),余Ⅳb-c、Ⅱ、 Ⅲa、c级皆为0个。2.随着膝关节屈曲角度由0°～60°之间变化,髌骨持续不断的向内侧移位；在Y轴上随着膝角的变化(0。-60。),髌骨的运动轨迹像正常人的运动轨迹一样持续不断的向下滑行；在Z轴上,随着膝曲角度的变化,髌骨滑行的轨迹是显著向前的。结论：将正常人和髌股关节对合不良患者的传统膝关节稳定性的测量值进行对比及两者的髌骨运动轨迹在三维坐标轴中的数值进行对比,可以得知,640层动态容积CT扫描成像不仅能像传统的膝关节测量值那样判断髌股关节的稳定性,而且可提供更加精确的坐标值,为临床对髌股关节稳定性的诊断提供提供更为全面的诊断方法和依据。

    The study was divided into two parts:(1) to discuss the application value of patellartracking in healthy human using volume scan on sensation640slices CT.(2) to discuss theapplication value of patellar tracking in patient with patellofemoral malalignment usingvolume scan on sensation640slices CT. The results obtained were compared with rusultswhich got in part one.Part I An application value of tracking movement of normal patellarusing volume scan on sensation640slices CT.Objective: In the condition of non weight bearing, to discuss the application value of usingthe technology of the volume scan on sensation640slices CT healthy human for patellartracking, and to provide the range and foundation of normal vulue for patient withpatellofemoral malalignment.Materials and Methods:Research objects: The prospective pilot study enrolled20healthy human beings inKowloon Hospital from2013.9to2013.11, including15men and5women. The ageranged18~51with average of35.95years old. Both sides of the knee joint of allparticipantors (40of the knee joint in all) were examined. All the human beings receivedexamination by using volume scan on Toshiba Aquilion one sensation640slices CT.Two different methods of measuring: The participantors lay on the examining table onsensation640slices CT and put both sides of the knee on the measuring table. The femoralepicondylar of healthy human were fastened to measuring table, which was parallel tofemoral epicondylar axis. By adjusting the center of whirlbone and the midpoint of the lineof medial and lateral, we could let knee joint be parallel to the measurement station. Theposition of knee extension was the starting point to measure the instability of the knee joint. The specific methods were as follows:(1).When the knee angle was30°，We couldobtain the numeric of the femoral trochlear angle、Congruence angle、Lateralpatellofermoral angle、patellofemoral index and patellar height.(2).Data of dynamic scansof40knees was collected by using volume scan on sensation640slices CT. when the kneeangle was0°，we could establish the3D coordinate with the origin of coordinates was thecenter of the patella. The data of movement of the patellorfemoral joint was obtainedduring flexion (from0°to60°) within12s by320CT from all human beings. The3Dcoordinate of the center of patella was got to analyse the dispose relation of thepatellorfemoral joint.Results: Totally40knee-joints were measured. The results were as follows:(1).Thepatellofemoral joint stability of results of the classification for the healthy human were asfollows: Ⅰa was4（10%），Ⅰb was2（5%），Ⅳa was24（60%）， Ⅳb was10（25%），Ⅰc、Ⅳc、Ⅱ、Ⅲ was also0.(2).When the knee flexion reached0°~10°，the patellar movement was an inward movement along the X-axis, andsubsequently moved to the opposite lateral direction ever since with the knee anglechanged from20°to60°.When the knee angle changed from0°to60°，the patella movedconstantly along the Y-axis direction down. In the Z-axis, the patellar tracking was alwaysan backward movement.At first, the ranges of patellar motion was no big change. As theknee angle changed from50°to60°，the patellar movement reached the largest range.Conclusion:The functional imaging of640slices CT not only provide the conventionalnumeric which can diagnose the stability of the Patellofemoral joint, but also get the threedimensional coordinate values to provide the clinician more comprehensive information todiagnose the involution of patellofemoral joint.PartⅡ An application value of tracking movement of patients withpatellofemoral malalignment using volume scan on sensation640slices CT.Objective: In the condition of non weight bearing, to discuss the application value ofpatellar tracking in patients with patellofemoral malalignment using volume scan onsensation640slices CT, we could compare and analyze with the results which obtained in part one.Materials and Methods: The prospective pilot study enrolled20patients withpatellofemoral malalignment in Kowloon Hospital from2013.9to2013.11, including9men and11women. The age ranged18-55with average of35.55years old. Both sides ofthe knee joint of all participantors (totally40the knee joint) were examined. All thehuman beings received examination by using volume scan on Toshiba Aquilion onesensation640slices CT. The specific measuring and statistical method was the same as thepart I.Results: Totally40knee-joints were measured. The results were as follows:(1).Thepatellofemoral joint stability of results of the classification for the patients withpatellofemoral malalignment were as follows: Ⅰa was9（22.5%），Ⅰb was25（62.5%），Ⅰc was3(7.5%),Ⅲb was2(5%),Ⅳa was1（2.5%）.Ⅳb、c、Ⅱ、Ⅲa、c was also0.(2).When the knee flexion reached0°-60°，the patellarmovement was an inward constantly movement along the X-axis. With the knee anglechanged from0°to60°，，the patella moved along the Y-axis direction down as the healthyhuman. In the Z-axis, the patellar tracking was always an backward significant movement.Conclusion: The traditional measurements and3D coordinate values were contrastedbetween healthy human and patients with patellofemoral malalignment. We know that thefunctional imaging scan of640slices CT not only provide the conventional numeric whichcan diagnose the stability of the Patellofemoral joint, but also get the more accuratecoordinate values to provide the clinician the new method and foundation to diagnose theinvolution of patellofemoral joint.

640层动态容积CT对正常人与髌股关节对合不良患者的髌骨运动轨迹的对比性研究

中文摘要4-7Abstract7-9引言11-13第一部分 640层动态容积CT对正常人髌骨运动轨迹的应用价值13-22    材料和方法13-16    结果16-18    讨论18-22第二部分 640层动态容积CT对髌股关节对合不良病人的髌骨运动轨迹的应用价值22-29    材料和方法22-23    结果23-26    讨论26-29参考文献29-32结论32-33附图33-37综述37-48    参考文献44-48中英文缩略词表48-49攻读学位期间公开发表的论文49-50致谢50-51

  本文关键词：640层动态容积CT对正常人与髌股关节对合不良患者的髌骨运动轨迹的对比性研究，由笔耕文化传播整理发布。