钳夹型股骨髋臼撞击症X线征象与髋关节活动度的相关性研究

发布时间：2018-07-03 06:04

本文选题：PINCER型股骨髋臼撞击综合征 + PINCER型股骨髋臼撞击综合征X线影像学征象　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:通过对比髋关节正位片上有PINCER型股骨髋臼撞击症(FAI)影像学征象存在者和无任何异常征象者的髋关节活动度,去研究当髋关节正位片上存在PINCER型FAI征象时髋关节活动度的变化。方法:筛选出2010年至2016年大连大学附属中山医院所有的髋关节正位片,经拟定的排除标准后,对于非标准髋关节正位片的患者,再次行标准髋关节正位片的拍摄:病人仰卧于摄影台上,人体正中矢状面垂直台面,两下肢伸直,双足轻度内旋10°-15°自然并拢,中心线通过髂前上棘连线中点与耻骨联合上缘连线的中点,曝光范围包括整个骨盆,管电压65KV,摄影距离为110-120cm。由两位高年资影像学医师在双盲的情况下对上述髋关节正位片进行PINCER型FAI影像学征象的筛选,共有265例(430髋);同时筛选出50例(100髋)无任何异常影像学征象的髋关节。根据有无PINCER型FAI影像学征象将上述患者分为研究组(265例,430髋)和对照组(50例,100髋)。并根据每种PINCER型FAI线影像学征象在髋关节正位片上的表现情况,将研究组分为5个亚组:A组:“交叉征”组;B组:“髋臼过深”组;C组:“交叉征+髋臼过深”组;D组:“髋臼过深+后壁征”组;E组:“髋臼突出+后壁征”组。采用统一的测量方法对上述所有髋关节进行活动度(前屈、后伸、内旋、外旋、内收、外展)的测量,同时检查前后撞击试验及“4”字试验,记录结果。研究组中每个亚组均与对照组做对比,并用SPSS17.0软件中独立样本T检验对两组关节活动度的差异进行统计学分析;采用卡方检验对前后撞击试验及“4”字试验阳性率的差异进行统计学分析。结果:上述样本全部纳入结果分析,两组样本的一般资料相比无统计学差异。研究结果如下:(1)“交叉征”组:共有101例,结果表明髋关节正位片上存在“交叉征”征象时髋关节活动度与正常组相比是有差异的,主要表现在屈曲(P0.001),内旋(P0.001),内收(P0.001),以及前撞击实验阳性(P0.001);(2)“髋臼过深”组:在该项研究中共123例,其关节活动度与正常组相比无明显变化,前屈(P=0.888),后伸(P=0.878),内旋(P=0.082),外旋(P=0.336),内收(P=0.845),外展(P=0.806),前后撞击试验及“4”字试验均为阴性;(3)“交叉征+髋臼过深”组:共77例,关节活动度异常主要表现在屈曲(P0.001),内旋(P=0.002),内收(P0.001),前撞击试验阳性(P0.001);(4)“后壁征”+髋臼过深”组:共67例,其关节活动度的变化表现在内旋(P0.001),外旋(P0.001),后伸(P0.001),前后撞击实验均为阳性(P0.001),“4”字试验阳性(P0.001)。(5)“后壁征+髋臼突出”共66例,其关节活动度表现为内旋(P0.001),外旋(P0.001),内收(P0.001),后伸(P0.001),前后撞击试验及“4”字试验阳性率差异有统计学意义(P0.001)。结论:当髋关节正位片上只存在“交叉征”征象时,髋关节活动度与正常髋关节相比是有差异的。而单纯的“髋臼过深”存在时对髋关节的活动度没有明显的影响。此外,当存在后壁过度覆盖这种解剖学异常时(后壁征),除了有后撞击试验阳性外,前撞击试验及“4”字试验也会表现为阳性。
[Abstract]:Objective: To study the changes in hip mobility in the presence of PINCER type FAI signs on the hip joint orthographic film by comparing the hip motion of the PINCER type femoral acetabular impingement (FAI) imaging findings and no abnormal signs on the hip joint orthotopic films. Methods: the Zhongshan Medicine Affiliated to the Dalian University from 2010 to 2016 was selected. After the proposed exclusion criteria, after the proposed exclusion criteria, for the patients with nonstandard hip joint position, the patients were taken again on the standard hip joint film: the patient was lying on the camera, the median sagittal vertical surface of the human body, the two lower extremity straightening, the mild internal rotation of the bipedal 10 degrees -15 degrees, and the center line through the anterior superior iliac spine line. Point with the middle point of the joint superior line of the pubis, the exposure range includes the entire pelvis, the tube voltage 65KV, and the distance of the photographing of 110-120cm. by two senior year imaging physicians to screen the PINCER FAI imaging signs of the above hip joint under the double blindness, with a total of 265 cases (430 hips); at the same time, 50 cases (100 hips) have no abnormality. According to the PINCER FAI imaging signs, the above patients were divided into the study group (265 cases, 430 hips) and the control group (50 cases, 100 hips). The study group was divided into 5 subgroups according to the performance of each PINCER type FAI line image on the hip joint: the A group: the "cross sign" group; the B group: "the over depth of the acetabulum." Group C: group C: "cross sign + acetabular deep" group; group D: "acetabular deep + posterior wall sign" group; group E: "acetabular protruding + posterior wall sign" group. The measurements of all hip joint activity (anterior flexion, extension, internal rotation, external rotation, adduction, abduction) were measured by a unified method, and the results of the impact test and the "4" test were recorded before and after examination. Record the results. Each group in the study group was compared with the control group, and the differences of the two groups of joint activity were statistically analyzed with the independent sample T test in the SPSS17.0 software. The difference between the positive rate of the front and back impact test and the "4" test was statistically analyzed with chi square test. The results were all included in the results analysis and two groups of samples. There was no statistical difference in the general data. The results were as follows: (1) the "cross sign" group: a total of 101 cases, the results showed that the hip joint activity was different from the normal group when there was "cross sign" sign on the hip joint, mainly in flexion (P0.001), internal rotation (P0.001), adduction (P0.001), and positive impact test positive. (P0.001): (2) "too deep acetabulum" group: 123 cases in this study, there were no obvious changes in the joint activity compared with the normal group, the flexion (P=0.888), the extension (P=0.878), the internal rotation (P=0.082), the external rotation (P=0.336), the adduction (P=0.845), the abduction (P= 0.806), the front and back impact test and the "4" test were all negative; (3) "cross sign + excessive acetabulum" group: a total of 7 In 7 cases, the abnormality of joint activity was mainly in flexion (P0.001), internal rotation (P=0.002), adduction (P0.001), positive impact test positive (P0.001); (4) "posterior wall sign" + excessive acetabulum group: a total of 67 cases (P0.001), external rotation (P0.001), extension (P0.001), and posterior impact test were positive (P0.001) and "4" test. Test positive (P0.001). (5) "posterior wall sign + acetabular protrusion" in 66 cases, its joint activity was internal rotation (P0.001), external rotation (P0.001), adduction (P0.001), extension (P0.001), the positive rate of front and back impact test and "4" test were statistically significant (P0.001). Conclusion: when there is only "cross sign" sign on the hip joint position, hip joint The activity degree is different from that of the normal hip joint. But the simple "acetabulum too deep" has no significant influence on the activity of the hip joint. In addition, when the posterior wall overlay the anatomic abnormalities (the posterior wall sign), the front impact test and the "4" word test will also be positive except for the positive post impact test.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684

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