股骨远端的三维测量与性别差异化股骨假体的改进分析
发布时间：2018-11-26 18:52
【摘要】： 第一部分股骨远端解剖形态性别差异与假体形态设计的关系 目的通过三维螺旋CT重建正常人膝关节,测量股骨远端相关解剖参数,探讨男女性股骨远端的解剖特点对于关节表面假体形态的不同要求。 方法80侧正常成人膝关节,男性、女性各40侧,年龄18～72岁,行三维螺旋CT扫描,在GE Advantage workstation工作站上进行0.625 mm层厚重建,在Geomagic Studio三维图像处理系统上模拟截骨,测量股骨经上髁轴线宽度、内外侧髁高度、髁间高度及内外侧滑车前突距离,以及相关截骨面参数,比较各测量值性别间的差异。 结果男女性髁间高度、经上髁轴线宽度、外侧髁高度及内侧髁高度均有显著性差异(P＜0.001),男性各值均大于女性。股骨远端横径与纵径的比值亦为男性大于女性(P＜0.001),男性股骨内、外侧滑车前突距离均大于女性,均值差分别为1.1 mm和0.7 mm,均有显著性差异(P＜0.001)。 结论男女性之间股骨髁形态存在一定差别,股骨远端关节面假体形态的设计应该性别差异化,使假体与截骨面更好的吻合。以提高全膝关节置换的手术效果。 第二部分三维螺旋CT重建股骨远端旋转力线的测量 目的通过三维螺旋CT重建正常成人膝关节,测量股骨远端旋转力线,为全膝关节置换术股骨假体旋转力线的定位提供理论依据。 方法80侧正常成人膝关节,男性、女性各40侧,年龄18～72岁,行三维螺旋CT扫描,在GE Advantage workstation工作站上进行0.625 mm层厚重建,测量股骨外科上髁轴线与股骨后髁轴线之间的夹角(股骨后髁角,PCA)及前后轴线的垂线与股骨后髁轴线的央角(APA),比较男女性股骨旋转力线的差异。 结果PCA:男性3.21°±1.35°(1.15°～5.92°),女性3.60°+1.40°(0.84°～5.76°);APA:男性3.17°±1.62°(0.87°～5.73°),女性3.66°±1.58°(1.34°±6.05°)。PCA与APA的差异无统计学意义,但性别间PCA及APA差异均有统计学意义,同时PCA和APA均有较大的个体差异。 结论男女性及不同个体之间股骨后髁角值存在一定差别,统一参照股骨后髁轴截骨将导致假体安放不准确,应采用多种定位方法确定股骨侧截骨,术前三维螺旋CT扫描重建股骨远端,测量后髁角,有利于术中重建准确的旋转力线。
[Abstract]:The first part the relationship between the sexual difference of anatomical morphology of distal femur and the shape design of prosthesis objective to reconstruct the normal knee joint by three-dimensional spiral CT and to measure the anatomical parameters of the distal femur. To explore the different requirements of the anatomical features of the distal femur of men and women for the morphology of the joint surface prosthesis. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning. The thickness of 0.625 mm layer was reconstructed on GE Advantage workstation. Osteotomy was simulated on Geomagic Studio 3D image processing system. The width of transepicondylar axis, the height of internal and external condyle, the height of intercondylar, the distance of anterior protrusion of trochlear and the parameters of osteotomy were measured. Results there were significant differences in the height of intercondylar between male and female, the width of axis of epicondyle, the height of lateral condyle and the height of medial condyle (P < 0.001). The ratio of transverse diameter to longitudinal diameter of distal femur was also larger in males than in females (P < 0.001). The distance between medial and lateral trochlear protrusions in males was larger than that in females, and the mean differences were 1. 1 mm and 0. 7 mm, respectively. There was significant difference between the two groups (P < 0.001). Conclusion there are some differences in the shape of femoral condyle between men and women. The design of the prosthesis of the distal femoral articular surface should be gender differentiated, so that the prosthesis and osteotomy surface can be better matched. In order to improve the operation effect of total knee arthroplasty. The second part the measurement of rotational force line of distal femur by three-dimensional spiral CT objective to reconstruct the normal knee joint by three-dimensional spiral CT and measure the rotational force line of distal femur. To provide theoretical basis for the positioning of rotation force line of femoral prosthesis in total knee arthroplasty. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning, and 0.625 mm thickness reconstruction was performed on GE Advantage workstation. The angle between the supracondylar axis and the posterior femoral condylar axis (, PCA) of the posterior femoral condyle and the central angle of the vertical axis of the posterior femoral condyle and the central angle of the posterior femoral condyle) were measured to compare the male and female femoral rotation force lines. Results PCA: was 3.21 掳卤1.35 掳(1.15 掳~ 5.92 掳) in male and 3.60 掳1.40 掳(0.84 掳~ 5.76 掳) in female. There was no significant difference between APA: male 3.17 掳卤1.62 掳(0.87 掳~ 5.73 掳), female 3.66 掳卤1.58 掳(1.34 掳卤6.05 掳). PCA) and APA, but there were significant differences in PCA and APA between male and female. At the same time, PCA and APA have great individual differences. Conclusion the angle of posterior femoral condyle is different between men and women and different individuals. Reference to osteotomy of posterior femoral condyle axis will lead to inaccurate placement of the prosthesis. Multiple localization methods should be used to determine femoral osteotomy. The reconstruction of distal femur and posterior condyle angle by three dimensional spiral CT scan before operation is beneficial to the reconstruction of accurate rotation force line.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R318.1;R322
本文编号：2359337
[Abstract]:The first part the relationship between the sexual difference of anatomical morphology of distal femur and the shape design of prosthesis objective to reconstruct the normal knee joint by three-dimensional spiral CT and to measure the anatomical parameters of the distal femur. To explore the different requirements of the anatomical features of the distal femur of men and women for the morphology of the joint surface prosthesis. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning. The thickness of 0.625 mm layer was reconstructed on GE Advantage workstation. Osteotomy was simulated on Geomagic Studio 3D image processing system. The width of transepicondylar axis, the height of internal and external condyle, the height of intercondylar, the distance of anterior protrusion of trochlear and the parameters of osteotomy were measured. Results there were significant differences in the height of intercondylar between male and female, the width of axis of epicondyle, the height of lateral condyle and the height of medial condyle (P < 0.001). The ratio of transverse diameter to longitudinal diameter of distal femur was also larger in males than in females (P < 0.001). The distance between medial and lateral trochlear protrusions in males was larger than that in females, and the mean differences were 1. 1 mm and 0. 7 mm, respectively. There was significant difference between the two groups (P < 0.001). Conclusion there are some differences in the shape of femoral condyle between men and women. The design of the prosthesis of the distal femoral articular surface should be gender differentiated, so that the prosthesis and osteotomy surface can be better matched. In order to improve the operation effect of total knee arthroplasty. The second part the measurement of rotational force line of distal femur by three-dimensional spiral CT objective to reconstruct the normal knee joint by three-dimensional spiral CT and measure the rotational force line of distal femur. To provide theoretical basis for the positioning of rotation force line of femoral prosthesis in total knee arthroplasty. Methods 80 normal adult knee joints, 40 male and 40 female, aged 1872 years, underwent 3D spiral CT scanning, and 0.625 mm thickness reconstruction was performed on GE Advantage workstation. The angle between the supracondylar axis and the posterior femoral condylar axis (, PCA) of the posterior femoral condyle and the central angle of the vertical axis of the posterior femoral condyle and the central angle of the posterior femoral condyle) were measured to compare the male and female femoral rotation force lines. Results PCA: was 3.21 掳卤1.35 掳(1.15 掳~ 5.92 掳) in male and 3.60 掳1.40 掳(0.84 掳~ 5.76 掳) in female. There was no significant difference between APA: male 3.17 掳卤1.62 掳(0.87 掳~ 5.73 掳), female 3.66 掳卤1.58 掳(1.34 掳卤6.05 掳). PCA) and APA, but there were significant differences in PCA and APA between male and female. At the same time, PCA and APA have great individual differences. Conclusion the angle of posterior femoral condyle is different between men and women and different individuals. Reference to osteotomy of posterior femoral condyle axis will lead to inaccurate placement of the prosthesis. Multiple localization methods should be used to determine femoral osteotomy. The reconstruction of distal femur and posterior condyle angle by three dimensional spiral CT scan before operation is beneficial to the reconstruction of accurate rotation force line.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R318.1;R322
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2 尚延春;陈海龙;王战朝;;引起全膝表面假体置换手术下肢力线不好的几个原因[J];中医正骨;2007年08期
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