成人股骨头坏死的应力机制研究

发布时间：2018-08-14 16:34

【摘要】：目的：通过回顾成人股骨头坏死影像学资料,分析日常生活中股骨头髋臼的应力分布特点及股骨头血供特点,统计分析出股骨头坏死区域与股骨头应力峰值区域及血供区域的相关性,提出股骨头坏死应力机制假说,强调应力因素在股骨头坏死发生及发展过程中的作用；把补益肝肾、强筋壮骨治法放在与活血化瘀、改善循环同等重要位置,从而更好地在临床上指导股骨头坏死这一骨科疑难病的预防和诊治。方法：收集广州中医药大学第一附属医院2014年4月～2015年4月确诊为股骨头坏死患者的髋关节螺旋CT影像资料共23份(40髋),其中男性15例,女性8例；年龄18-47岁,平均年龄33岁；ARCO分期：Ⅰ期2髋,Ⅱ期16髋,Ⅲ期21髋,Ⅳ期1髋；发病原因：创伤性坏死5髋,激素性坏死18髋,酒精性坏死14髋,特发性坏死3髋。运用Mimics软件分别重建其股骨头三维影像,确定坏死区域及相对应坏死中心点。根据股骨头日常生活中承受应力的特点,将股骨头划分为顶柱、前侧柱、外侧柱及后侧柱四个区域,其中顶柱、前侧柱、外侧柱为股骨头日常承受应力较集中区域,后侧柱为股骨头血供分布较集中区域。拟定股骨头中垂线周围40度范围为顶柱,其外侧为外侧柱,前方为前侧柱,后方为后侧柱。将各病例股骨头坏死中心点与股骨头应力柱区域一一对应,收集数据,建立数据库,进行数据统计分析。结果：23份病例髋关节螺旋CT影像资料(40髋)均成功进行三维重建,其中坏死中心点位于顶柱的有4髋,位于前侧柱的有8髋,位于外侧柱的26髋,位于后侧柱的2髋,经单样本卡方检验(X2=1.11,P0.05),差异有统计学意义。结论：①日常生活中股骨头应力集中区域在股骨头顶柱及前外侧柱,股骨头发生坏死及塌陷的部位主要集中在此区域；②股骨头血液供应主要分布在股骨头后方,股骨头坏死及塌陷反而较少发生在该区域,坏死分布与血供分布并不相符；
[Abstract]:Objective: To analyze the stress distribution and blood supply of femoral head and acetabulum in daily life by reviewing the imaging data of adult femoral head necrosis of femoral head, and to analyze the correlation between femoral head necrosis area and femoral head stress peak area and blood supply area. Methods: The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from April 2014 to April 2015 was collected. Twenty-three cases (40 hips) of femoral head necrosis were diagnosed by spiral CT, including 15 males and 8 females, aged 18-47 with an average age of 33; ARCO staging: 2 hips in stage I, 16 hips in stage II, 21 hips in stage III, and 1 hip in stage IV; pathogenesis: traumatic necrosis of 5 hips, hormone necrosis of 18 hips, alcoholic necrosis of 14 hips, and idiopathic deterioration. Three hips were dead.Three-dimensional images of the femoral head were reconstructed with Mimics software to determine the necrotic area and the corresponding necrotic center.According to the characteristics of daily stress of the femoral head,the femoral head was divided into four areas:the top column,the front column,the lateral column and the posterior column. The central point of femoral head necrosis was corresponded with the stress column area of femoral head. Data were collected, a database was established, and the data were statistically analyzed. Results: The spiral CT images of 23 cases (40 hips) were reconstructed successfully. There were 4 hips with necrosis center at apex, 8 hips with anterior column, 26 hips with lateral column and 2 hips with posterior column. The difference was statistically significant by single sample chi-square test (X2 = 1.11, P 0.05). The stress concentration area of the femoral head is located in the top column and anterolateral column of the femoral head, and the necrosis and collapse of the femoral head are mainly concentrated in this area. The blood supply of the femoral head mainly distributes behind the femoral head, whereas the necrosis and collapse of the femoral head rarely occur in this area.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.8

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