基于股骨侧关节假体设计的东北地区成人股骨近端解剖参数的测量

发布时间：2018-01-22 02:52

本文关键词： 股骨近端解剖参数假体设计　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：测量东北地区成人股骨近端解剖参数，用以指导关节置换的术前计划和假体选择，同时为设计更符合国人解剖特点的人工髋关节假体提供数据支持。方法：在吉林大学中日联谊医院影像系统Centricity RIS/PACS CE中，随机选取成人标准双髋正位x线平片，男女各50例。每例x线片均使用Centricity RIS/PACS CE直接测量股骨近端下列参数：股骨头直径，颈干角，股骨颈长，偏心距，大粗隆高点高于股骨头旋转中心的高度，股骨距区域皮质弧度，小粗隆高点水平股骨髓腔内径（Dt），小粗隆高点水平远端20mm处髓腔内径（Dt-20），小粗隆高点水平近端20mm（Dt+20）和近端10mm（Dt+10）髓腔内径，股骨峡部髓腔内径（Di），峡部水平到小粗隆高点水平的垂直距离（H），以及由上述各参数处理后得出的髓腔开口指数CFI（Dt+20/Di），干骺端髓腔开口指数MCFI1（Dt+20/Dt-20），以及干骺端髓腔开口指数MCFI2(Dt+10/Dt-20)。直接测量的数据经软件校正系数校正后，运用sPSS13.0进行统计学分析，所有数据用均数±标准差表示，男女之间行两独立样本t检验，左右之间行配对t检验，各参数之间行相关性分析。并通过样本均数估计总体均数的方法将数据结果与国内外其他研究进行比较。结果：股骨头直径为48.64±4.09mm，颈干角为126.4±4.6°，股骨颈长为51.37±5.69mm，偏心距为41.29±5.73mm，大粗隆尖高于股骨头旋转中心的高度为7.86±4.51mm，股骨距区域内侧皮质弧度为0.49±0.17rad，小粗隆高点水平近端20mm处髓腔内径为43.83±4.90mm，近端10mm处股骨髓腔内径为33.69±4.12mm，小粗隆高点水平股骨髓腔内径为27.22±3.53mm，远端20mm处股骨髓腔内径为19.58±2.61mm，股骨峡部髓腔内径为10.92±1.60mm，峡部水平到小粗隆高点水平的距离为98.97±14.82mm，髓腔开口指数CFI为4.10±0.73，干骺端髓腔开口指数MCFI1为2.26±0.21，，MCFI2为1.73±0.14。各参数左右侧比较差异均无统计学意义（p0.05）；除颈干角、大粗隆最高点与旋转中心的高度差、股骨距区域皮质弧度、CFI四项参数外，其余参数男女之间差异有统计学意义（p0.05），女性CFI4.7者所占比率（24%）高于男性（14%）。偏心距、Dt-20、Di、MCFI1、CFI等五项参数在不同年龄组间差异有统计学意义（p0.05）。与国内其他地区及国外多个研究结果比较，多项参数间存在显著差异（p0.05）。结论： 1、东北地区成人股骨近端髓腔形态多项参数在左右侧无显著差异，不同年龄组之间、男女性别之间有显著差异。与国内北京、江苏、湖南等地区的部分研究间多项参数差异存在统计学意义。与国外比较多有显著差异。 2、股骨近端髓腔形态多项参数间具有相关关系，干骺端髓腔随着年龄增大而呈现“烟囱型”的比例更大。女性较男性而言，呈现“漏斗型”的比例更大。 3、股骨距区域内侧皮质内缘的弧度可以作为股骨柄假体设计和选择的一个参数。 4、大粗隆高点与股骨头旋转中心不在一个水平面，多数高于旋转中心且平均高度差不到1cm，可以作为术中控制下肢长度的参考。 5、应设计符合国人解剖特点的假体。在进行假体设计和术中假体置入时应考虑国人股骨近端髓腔形态特点。
[Abstract]:Objective: to measure the anatomical parameters of proximal femur in adults in Northeast China, so as to guide preoperative planning and prosthesis selection for joint replacement, and to provide data support for designing hip prosthesis which is more suitable for Chinese anatomy.
Methods: in the imaging system of Centricity RIS/PACS in China Japan Union Hospital of Jilin University in CE, randomly selected adult standard double hip anteroposterior X-ray film, 50 cases of male and female. In each case the X-ray was used Centricity RIS/PACS CE to directly measure the following parameters: proximal femoral head diameter, neck shaft angle, femoral neck length, eccentricity. The greater trochanter high above the center of rotation of the femoral head height, femur cortical area radian, the lesser trochanter high level of femoral medullary cavity diameter (Dt), the lesser trochanter high level 20mm distal medullary cavity diameter (Dt-20), the lesser trochanter high level proximal 20mm (Dt+20) and proximal 10mm (Dt+10) medullary cavity diameter, femoral isthmus diameter (Di), isthmus level vertical distance to the lesser trochanter high level (H), and the medullary cavity of the above parameters is obtained after the treatment by the opening of the CFI index (Dt+20/Di), metaphyseal medullary cavity opening refers to the number of MCFI1 (Dt+20/Dt-20), and metaphyseal marrow cavity An index of MCFI2 (Dt+10/Dt-20). The data of the direct measurement of the software correction coefficient after correction, using sPSS13.0 for statistical analysis, all data with the mean standard deviation of that between men and women for two independent samples t test, or between the paired t test, correlation analysis performed between the parameters. And through the sample number estimation method the overall mean of the data results were compared with other studies at home and abroad.
Results: the femoral head diameter was 48.64 + 4.09mm, 126.4 + collodiaphyseal angle of 4.6 degrees, the long neck of the femur was 51.37 + 5.69mm, 41.29 + 5.73mm eccentricity, the greater trochanter height of the toe is higher than the center of rotation of the femoral head was 7.86 + 4.51mm, the calcar region of medial cortex radian was 0.49 + 0.17rad, the lesser trochanter high level of 20mm in the proximal medullary cavity diameter was 43.83 + 4.90mm, 10mm proximal femoral bone marrow cavity diameter was 33.69 + 4.12mm, high level of the lesser trochanter femoral medullary cavity diameter was 27.22 + 3.53mm, 20mm distal femoral marrow cavity diameter was 19.58 + 2.61mm, femoral isthmus diameter was 10.92 + 1.60mm, isthmus to the level of the lesser trochanter high level distance was 98.97 + 14.82mm, canal flare index CFI was 4.10 + 0.73, metaphyseal medullary cavity opening index MCFI1 was 2.26 + 0.21, 1.73 + MCFI2 0.14. parameters of left and right sides showed no significant difference (P0.05); the collodiaphyseal angle, the greater trochanter the highest point The height difference between the center of rotation of the femur cortical region arc, CFI four parameters, there were significant differences between men and women of other parameters (P0.05) CFI4.7, female ratio (24%) than men (14%). Dt-20, Di, eccentricity, MCFI1, the five parameters of CFI in different age differences between the groups was statistically significant (P0.05). Compared with other regions in the country and overseas research results, there are significant differences between the parameters (P0.05).
Conclusion:
1, the northeast region of adult proximal femoral medullary cavity shape parameters had no significant difference in the left and right side, between different age groups, there are significant differences between male and female. With the domestic Beijing, Jiangsu, was statistically significant difference between the parameters of part of the Hunan area between abroad and more. There are significant differences.
2, there was a correlation between the parameters of the proximal femoral medullary cavity and many parameters. The proportion of the metaphyseal pulp cavity increased with age. The proportion of the "funnel type" of the female was greater than that of the male.
3, a parameter of the calcar region of medial cortex inner radian can be used as the design and selection of femoral prosthesis.
4, the greater trochanter height and the femoral head rotation center are not on a horizontal plane, most of which are higher than the center of rotation, and the average height difference is less than 1cm, which can be used as a reference to control the length of the lower extremities during operation.
5, a prosthesis should be designed in accordance with the characteristics of the national anatomy. The morphological characteristics of the proximal femoral medullary cavity should be taken into consideration in the design of prosthesis and the implantation of prosthesis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R318.17

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