动态测量非生理状态下髋臼前倾角、外展角及其临床意义

发布时间：2018-04-19 00:05

本文选题：多排螺旋CT + 髋臼　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:通过多排螺旋CT(Multi-slice spiral computedtomography,MSCT)三维重建骨盆,测得骨盆在不同倾斜程度下髋臼前倾角和外展角数值,运用统计学软件计算前倾角和外展角的平均值和标准差,并绘制出其与骨盆倾度的相关性变化曲线,从中找到规律,指导非生理状态下全髋关节置换术(total hip arthroplasty,THA)个体化置入髋臼假体的放置角度。方法:本研究选择50位患者(即100个髋臼)为研究对象进螺旋CT扫描,利用容积再现(volume rendering technique即VRT)技术把骨盆重建为立体图像,进而对骨盆进行不同程度的前倾(以10°为间隔,从10°前倾到90°),利用多平面重组(multi-planar reconstructions即MPR)分别重建出冠状位及水平位图像,进而分别测得两侧外展角、计算两侧前倾角。前倾角的测量方法,每个髋臼都要测得上、中、下三个平面的前倾角,以髋臼的最大层面为中间层面,上层面位于中间层面的上一层,下层面则位于中间层面的下一层,间隔为5mm。依据前倾角的定义,在水平位上髋臼前后缘点连线与双侧髋臼后缘连线的夹角的余角作为前倾角,并对上、中、下三个层面进行测量和计算,所得平均值即为前倾角。外展角也要测前、中、后三个平面,以髋臼的最大层面为中间层面,前层面位于中间层面的前一层,后层面则位于中间层面的后一层,间隔为5mm。根据外展角的定义,在冠状位上髋臼上下缘连线和双侧髋臼下缘连线的夹角为外展角,并对前、中、后三个层面进行测量和计算,所得平均值即为外展角。选垂直于地面的面为基准平面,把骨盆前平面(两侧髂前上棘与耻骨联合前缘所构成的面)定为参照平面,二者之间的角度即为骨盆前倾角度。为模拟病理状态,则改变骨盆倾度,把骨盆分别进行10-90°的倾斜(以10°为间隔),分别测出骨盆倾度在10-90°下前倾角和外展角,采用统计学软件计算平均值和标准差,绘制出非生理状态下髋臼前倾角和外展角随骨盆倾度改变而发生变化的相关性变化曲线,从中找到规律,为临床THA手术置入髋臼假体放置角度提供相关的理论依据。结果:对测得的数据分成男性、女性和混合三组做统计学处理,求出各组平均值和标准差,并进行显著性检验,当P0.05时,说明差异有统计学意义。以骨盆倾度为横坐标,髋臼前倾角和外展角为纵坐标,绘制出骨盆倾度与髋臼两角的相关变化曲线。MSCT法检测髋臼前倾角结果如下:当骨盆倾度从10°逐渐增加至90°时,前倾角随之减小,变化曲线呈线性相关,拟合后得到的回归方程为y=-0.4582x+40.714,r=0.996,线性良好。根据方程计算可知,当骨盆倾度达到83°时,前倾角可达0。MSCT法检测髋臼外展角结果如下:当骨盆倾度从10°逐渐增至90°时,外展角的变化曲线呈抛物线。当骨盆倾度为60°-70°之间时,外展角最大,处于42°-48°之间,说明此状态下的髋臼对股骨头覆盖最好,关节的稳定性也最佳。另外本研究还分析了性别对髋臼前倾角和外展角的影响,结果表明在相同条件下,所得的不同性别之间的前倾角和外展角并无显著性差异(P0.05)。结论:1.髋臼的前倾角和外展角随着骨盆倾度的变化而发生改变。髋臼的前倾角与骨盆倾度呈线性相关。外展角的变化曲线呈抛物线。骨盆的倾斜程度敏感地影响髋臼的前倾角和外展角的变化。髋臼两角随骨盆倾度动态变化的规律,可以为临床THA手术中髋臼假体放置角度提供理论依据。2.根据比较不同性别髋臼前倾角和外展角,结果发现不同性别之间的髋臼前倾角、外展角没有显著性差异。这说明性别因素对髋臼的前倾角和外展角的影响不大。
[Abstract]:Objective: by multi-slice spiral CT (Multi-slice spiral computedtomography, MSCT) three dimensional reconstruction of pelvis, pelvic tilt measured in different degrees of acetabular anteversion and abduction angle of numerical calculation, abduction angle and anteversion angle of the average value and standard deviation of the use of statistical software, and draw out the changes associated with pelvic inclination of the curve, find from the law, to guide the non physiological state of total hip arthroplasty (total hip, arthroplasty, THA) position of the individual placement of the acetabular component. Methods: This study selected 50 patients (100 hips) in spiral CT scan as the research object, using volume rendering (volume rendering technique VRT) technology to the pelvis for the reconstruction of stereo images, and different degrees of anteversion of the pelvis (at 10 degrees intervals from 10 degrees to 90 degrees forward), multi planar reconstruction (multi-planar reconstructions MPR) were reconstructed Coronal and horizontal images, which were measured on both sides of the abduction angle and anteversion angle measurement method. The calculation on both sides of the acetabular anteversion, each must be measured, and the three plane angle, to the maximum level of acetabular for the middle layer, the upper surface is located in the middle level of the lower layer. The surface is located in the middle level of the next layer interval for the definition of 5mm. according to the anteversion angle, angle margin line and bilateral acetabulum attachment in the horizontal position of the acetabular anteversion angle as before and after, and, in three aspects of measurement and calculation, the average value is the anteversion. To measure the abduction angle before, after the three plane, with the maximum level of acetabular for middle level, before the level is located in the middle level before, after the level is located in the middle level after an interval of 5mm. layer, according to the definition of the abduction angle in coronal position, suprainferior margin. The angle between the line and the lower edge of the connection for the bilateral acetabular abduction angle, and before, after three levels were measured and calculated, the average value is selected. The abduction angle perpendicular to the ground surface as the reference plane, the anterior pelvic plane (on both sides of the anterior superior iliac spine and the pubic symphysis of the front surface) as a reference plane, the two is the angle between the pelvis forward angle. In order to simulate the pathological state, change the inclination of pelvis, pelvic tilt were 10-90 degrees (10 degrees apart), pelvic inclination were measured at 10-90 degrees under the abduction angle and anteversion angle, calculate the average value and standard deviation of the statistical software, draw the correlation curve of the non physiological state of acetabular abduction angle and anteversion angle with the pelvis inclination change, find the law, provide relevant theoretical basis for the clinical operation of THA implanted acetabular prosthesis placement angle. Results: the measured The data are divided into three groups of male, female and mixed groups were calculated statistically, the mean and standard deviation, and significant test shows that when P0.05, the difference was statistically significant. The pelvic inclination as abscissa, acetabular abduction angle and anteversion angle as the ordinate, draw the relevant changes in pelvic and acetabular inclination the detection method of.MSCT curve of Liangjiao acetabular anteversion results are as follows: when the pelvic inclination from 10 degrees to 90 degrees increased gradually when the anteversion angle decreases, a linear correlation curve fitting, the regression equation obtained after y=-0.4582x+40.714, r=0.996, linear calculation. According to the equation, when the inclination of 83 degrees of pelvis, detection the acetabular abduction angle up to 0.MSCT results are as follows: when the pelvic inclination angle from 10 degrees to 90 degrees gradually when the curve of the abduction angle of the parabola. When the pelvis inclination is between 60 DEG -70 DEG, abduction angle in the 4 largest. Between 2 -48 degrees, the state of the acetabulum of the femoral head covering best joint stability is also the best. This study also analyzed the impact of gender on acetabular anteversion and abduction angle. The results show that under the same conditions, between different gender the abduction angle and anteversion angle had no difference (P0.05). Conclusion: 1. acetabular abduction angle and anteversion angle changes with the change of pelvic inclination. Acetabular anteversion and inclination of pelvis showed a linear correlation curve. The abduction angle was parabola. Changes in tilt of the pelvis is sensitive to the effects of acetabular abduction angle and anteversion angle of the acetabular angles change with pelvic inclination. Dynamic rules, can provide a theoretical basis of.2. according to the comparison of different gender of acetabular abduction angle and anteversion angle of acetabulum prosthesis in clinical THA surgical placement of the acetabular anteversion results between different sexes, outside There is no significant difference in the angle of the abduction. This shows that the gender factors have little effect on the anteversion angle and abduction angle of the acetabulum.

【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】：R687.4

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