保留股骨颈型全髋关节置换术股骨侧假体型号的选择与股骨近端髓腔参数的相关性研究

发布时间：2018-05-07 23:04

本文选题：股骨髓腔测量 + 股骨近端参数　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:明确股骨近端髓腔形态学参数受到哪些因素影响,明确股骨颈保留型全髋关节置换术中股骨假体型号选择的规律性,为股骨颈保留型全髋关节置换提供术前假体型号准备,减少手术时间、提高假体固定的精确度、增加手术的安全性。方法:选取2015年8月至2016年8月河北医科大学第三医院骨病科完成的应用CFP假体进行的全髋关节置换术患者为研究对象,共测量CFP假体全髋关节置换术后157例患者200髋;其中男性99人123髋,年龄48.2±11.9岁,最大76岁,最小22岁;女性58人77髋,年龄53.3±12岁,其中最大74岁,最小28岁;左侧87髋,右侧113髋。应用PACS系统自带的测量软件进行股骨近端相关参数的测量,测量指标包括小转子中点水平股骨髓腔内径(T0)、小转子中点水平上20mm股骨髓腔内径(T+20)、小转子中点水平下20mm股骨髓腔内径(T-20)、CFP假体末端股骨髓腔内径(T端)、股骨峡部髓腔内径(T峡内)、股骨峡部外径(T峡外)、股骨头偏心距(offset)、残留股骨颈高度(H残颈)、峡部位置(H峡高),计算股骨近端髓腔闪烁指数(CFI)、股骨干骺端髓腔开大指数(MCFI)、股骨远端髓腔开大指数(DCFI)、皮质指数(CI)、皮质厚度、柄端距峡部的距离(H峡余)等参数;同时记录患者性别、年龄、身高、体重、体重指数(BMI)。通过统计学处理:各参数用均数±标准差表示,参数间差别比较用t检验或方差分析、参数间相关性应用相关分析。结果:1测得T+20为43.81±4.28mm,T-20为26.48±3.42mm,T0为18.78±2.63mm,T端为12.62±2.04mm,H柄高为64.14±10.16mm,T峡内为11.06±2.09mm,T峡外为27.08±2.79mm,H峡高为105.99±11.98mm,H峡余为41.85±12.55mm,H残颈为18.38±3.67mm,offset为42.50±6.19mm,CFI为4.18±0.82,MCFI为2.42±0.31,DCFI为1.73±0.24,CI为0.57±0.08,皮质厚度为7.51±1.39。2本组与国内其他研究组测量值相比较无统计学意义,与Noble组及Massin组比较T+20、T0、T-20、T峡内、峡部位置均减小,有统计学意义。3左右侧股骨近端相关参数比较无显著性差异;左右侧假体型号选择亦无显著差异。4男女性别间T+20、T0、T-20、T峡内差异有统计学意义,男性股骨近端髓腔较女性大;术中实际男女性使用假体型号,男性患者以M号为主,女性患者以S号为主。5身高与股骨近端髓腔参数有较强正相关性,与股骨假体型号呈正相关。体重及体重指数与峡部外径、皮质厚度存在正相关。6 DDH组T+20、T0、T-20、T峡内、峡部位置较其他组为小,差异有统计学意义,而其他疾病组间差异无统计学意义。DDH患者临床手术过程中使用股骨柄型号以XS、S号为主。7 T0、T-20在不同股骨柄型号间比较差异有统计学意义,T+20无统计学意义;CFP股骨柄型号选择与T0、T-20呈较强的正相关性,与T+20无明显相关性。8峡部髓腔内径与CFP柄端部髓腔内径呈强的正相关,与股骨柄型号选择存在强正相关。9 CFI、MCFI、Noble分型与股骨柄选择存在强相关性,DCFI与股骨柄型号选择存在弱相关。结论:1国人股骨近端髓腔径线较欧美人小,倒香槟瓶型髓腔较欧美人比例大;术中使用CFP假体型号集中于XS-M号,不呈正态分布而偏向小号假体,说明基于西方人较大骨骼设计的CFP假体相对于国人偏大。2身高与股骨近端髓腔参数及CFP股骨柄型号呈正相关性,随着身高增大,股骨近端髓腔径线相应变大,使用CFP假体型号也增大。3不同疾病组间比较,髋关节发育不良患者股骨近端髓腔径线偏小,手术时需要准备较小型号假体,或准备远端较细的先髋假体。4 CFP假体型号与小转子中点、小转子中点水平下20mm、峡部髓腔内径关系密切,以上三点处髓腔宽大患者需要使用较大型号CFP假体。5 CFI、MCFI能很好的反应股骨近端及大粗隆处髓腔形态,与CFP假体型号高度相关,CFI、MCFI越小使用CFP假体型号越大。
[Abstract]:Objective: to determine the influence of the morphological parameters of the proximal femoral medullary cavity, to clarify the regularity of the selection of femoral prosthesis in the femoral neck reserved total hip replacement, to provide the preoperation model preparation for the femoral neck reserved total hip replacement, to reduce the operation time, to improve the accuracy of the prosthesis fixation, and to increase the safety of the operation. Methods: the total hip arthroplasty performed by the CFP prosthesis of the orthopedics department of the Third Hospital of Hebei Medical University from August 2015 to August 2016 was studied. 157 patients with 200 hips after total hip replacement of CFP prosthesis were measured. Among them, 99 were 123 hips, 48.2 + 11.9 years old, the maximum 76, and the smallest 22 years old; and 58 women of 58 77. The hip, age 53.3 + 12 years old, the maximum 74 years old, the smallest 28 years old, the left 87 hip and the right 113 hip. The measurement of the proximal femur related parameters with the PACS system was used to measure the femoral medullary diameter of the middle point of the small rotors (T0), the middle point level of the 20mm femur cavity (T+20) at the middle point of the small trochanter, and the middle point level of the small rotors at the 20mm level. The intramedullary diameter of the femoral medulla (T-20), the internal diameter of the femoral medullary cavity at the end of the CFP prosthesis (T end), the internal diameter of the femoral medullary cavity in the femoral isthmus (T isthmus), the external diameter of the femoral isthmus (outside the isthmus of T), the femoral head eccentricity (offset), the residual neck height of the femur (H remnant neck), the position of the isthmus (H gorge), the calculation of the proximal femur medullary scintillation index (CFI), the large index of the femoral metaphyseal marrow cavity (MCFI), femur far (MCFI), and femur far away The parameters of large index (DCFI), cortical index (CI), cortical thickness, distance from the stem to the isthmus (H gorge), and the sex, age, height, weight, and body mass index (BMI) of the patients were recorded at the same time. By statistical treatment, the parameters were shown by mean number + standard difference table, and the difference of parameters was compared with t test or variance analysis and correlation application between parameters. Results: 1 T+20 is 43.81 + 4.28mm, T-20 is 26.48 + 3.42mm, T0 is 18.78 + 2.63mm, T end is 12.62 + 2.04mm, H handle is 64.14 + 10.16mm, T isthmus is 11.06 +, 27.08 +, 105.99 +, 41.85 + and 41.85 +. 2.42 + 0.31, DCFI 1.73 + 0.24, CI 0.57 + 0.08, cortical thickness 7.51 + 1.39.2 compared with other domestic research group, no statistical significance, T+20, T0, T-20, T isthmus, T+20, T0, T-20, and T isthmus, there were statistically significant differences in the proximal left femur related parameters of.3, and there was no significant difference between the left and right proximal femur. There was no significant difference in the selection of the side prosthesis of.4, T+20, T0, T-20, and T in the isthmus of the male. The male femur proximal medullary cavity was larger than that of the female; the male patients were mainly the male patients in the operation, the male patients were mainly M, and the female patients with S number.5 were strongly correlated with the proximal femoral medullary cavity parameters, and the femur was false. Body body number is positive correlation. Body weight and body mass index and isthmus outer diameter, cortical thickness exists in.6 DDH group T+20, T0, T-20, T isthmus, the location of isthmus is smaller than the other groups, the difference is statistically significant, but there is no statistical significance in other disease groups, and there is XS in the femoral stem type in the clinical operation process of the patients with.DDH, S is the main.7 T0, T-20 is at the T-20 in the course of clinical operation. There was no statistical significance between different types of femoral stem models, and there was no statistical significance in T+20. The selection of CFP femur handle model was positively correlated with T0 and T-20, and there was no significant correlation with T+20. There was a strong positive correlation between the inner diameter of.8 isthmus pulp cavity and the inner pulp cavity of the CFP handle, and there was a strong positive correlation with.9 CFI, MCFI, Noble classification and share with the selection of the femur stalk type. There is a strong correlation between the selection of the bone handle and the weak correlation between the selection of DCFI and the type of the femoral stem. Conclusion: the proximal femoral medullary diameter of the 1 Chinese people is smaller than that of the European beauty. The inverted champagne bottle cavity is larger than the European beauty. The model of the CFP prosthesis in the operation is concentrated on XS-M and does not present a normal distribution to the small prosthesis, indicating the C based on the large bone design of the westerners. There is a positive correlation between the height of the FP prosthesis relative to the large.2 of the country and the proximal femoral medullary parameters of the femur and the type of the CFP femur. As the height increases, the proximal femoral medullary diameter of the femur becomes larger, and the use of the CFP prosthesis also increases the comparison between the different.3 groups. The proximal femoral medullary diameter of the hip dysplasia is smaller and the operation needs less preparation. The model prosthesis, or the preparation of the.4 CFP prosthesis of the small distal hip prosthesis and the midpoint of the small trochanter, the midpoint level of the small rotors, 20mm, the internal diameter of the isthmus pulp cavity are closely related, the larger patients of the medullary cavity at three points need to use the larger type CFP prosthesis.5 CFI, and MCFI can respond well to the shape of the proximal and large trochanteric lumen of the femoral bone and the model of the CFP prosthesis. Highly correlated, the smaller the CFI and MCFI, the larger the CFP prosthesis type.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】