TileB2型骨盆骨折致创伤性髋股撞击征的计算机模拟及影像学测量研究

发布时间：2018-04-18 16:41

本文选题：髋 + 骨盆　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的探讨TileB2型骨盆骨折致创伤性髋股撞击征(femoroacetabular impingement, FAI)的发生发展机制,并分析影响TileB2骨盆骨折致创伤性髋股撞击征发生的相关因素。方法(1)3D模型建立阶段：应用Mimics软件基于CT断层图像建立骨盆和髋关节3D数字模型,以模拟骨盆骨折和髋关节运动。基本步骤包括：①影像数据采集;②数据保存及传输；③阈值设定,影像编辑分割；④建立3D模型。(2)计算机模拟和影像测量阶段：①结合髋关节运动特点和TileB2型骨盆骨折的侧方压迫损伤机制对髋关节旋转中心和髂骨内旋旋转中心进行设置；②计算机模拟TileB2型骨盆骨折和髋关节的运动；③通过模拟过程中的CT逆向显示技术对髋关节进行影像测量,测量距离为髋臼后缘与股骨头颈结合处的皮质骨与软骨下骨的结合点(distance from the junction of the femoral neck and head to posterior edge of acetabulum, DFPA);④使用SPSS统计学软件对测量数据进行统计分析。(3)临床测读方法验证阶段：模拟TileB2型骨盆骨折,并应用健-患侧外展角差值法对其进行测量,验证计算机模拟与临床CT测读诊断的互易性。基本步骤包括：①设置TileB2型骨盆骨折的旋转中心；②模拟骨盆骨折；③采用健-患侧外展角差值法对骨盆旋转进行CT影像测量；④配对t检验统计分析。结果(1)建立了适合髋关节运动学模拟和影像测量研究的骨盆和髋关节3D模型。其中股骨体积164838mm3,表面积19853mm2,由8884个三角形和4472个点组成；髂骨体积314552mm3,表面积59035mm2,由40366个三角形和20245个点组成。(2)对髋关节运动动态模拟发现：正常髋关节运动并非直线性运动,而是类似反比例函数曲线运动模式。曲线斜率逐渐减小,趋于水平,DFPA逐渐趋于常数值。当髋臼内旋时,DFPA在呈整体性动态下移趋势,曲线斜率减小,曲线逐渐趋于水平。静态模拟发现：DFPA与髋臼内旋角度呈直线性相关,并计算出每个后伸角度时的回归方程参数。(3)实验组与对照组测量结果总体比较无显著差异(t=-1.983,P=0.067),其灵敏度为80.95%。结论(1)应用Mimics软件建立骨盆和髋关节3D模型,操作便捷,模型外形逼真,数据精确,片面分布规则。Mimics软件功能强大,可应用3D模型模拟骨盆骨折和髋关节运动,其模拟过程可在CT断层扫描影像界面实时逆向显示,能够对其进行精确地影像学测量。(2)创伤性髋股撞击征的计算机模拟和影像学测量发现：①TileB2型旋转不稳定性骨盆骨折在导致髋臼内旋时,会使髋关节后方过度覆盖,是造成FAI的危险因素；②TileB2型骨盆骨折导致髋股撞击征的发生与以下两个因素有关：髋臼内旋角度和髋关节运动幅度。(3)临床上应用健-患侧外展角差值法测量骨盆骨折后髋臼旋转角度与实际情况无显著差异,其灵敏度较高,能够较准确的反映骨盆骨折后髋臼的旋转角度,即实验CT影像测量结果与临床CT测读结果具有互易性,但临床应用时应注意其适应征和操作要求。
[Abstract]:Objective to explore the mechanism of occurrence and development of femoroacetabular impingement (FAI) caused by TileB2 pelvic fracture, and analyze the related factors affecting the occurrence of traumatic hip joint impingement syndrome caused by TileB2 pelvic fracture.
Methods (1) stage 3D model: the application of Mimics software to establish the pelvic and hip joint CT images based on 3D digital model, to simulate the fracture of pelvis and hip joint motion. The basic steps include: first, the acquisition of the image data; the data storage and transmission; the threshold setting, editing the image segmentation; 3D model (. 2) stage of computer simulation and image measurement: the combination mechanism of lateral compression injury of hip joint movement and pelvic fracture of type TileB2 to set the center of rotation of the hip and ilium; simulation of TileB2 pelvic fracture and hip joint of computer movement; through the simulation process of CT reverse image display measurement of hip joint technology, measuring the distance for the combination point of the cortical bone and cartilage by bone and acetabular posterior edge of femoral head and neck (distance from the junction of the femoral neck and hea D to posterior edge of acetabulum, DFPA); the use of SPSS statistical software for statistical analysis of the measurement data. (3) clinical reading method validation stages: Simulation of type TileB2 pelvic fracture, and the application of health - patient abduction angle difference method to measure the validation of computer simulation test and diagnosis of reciprocal reading clinical CT. Basic steps include: setting the center of rotation of the type TileB2 pelvic fracture; simulates pelvic fracture; the health - patient abduction angle difference of pelvic rotation CT imaging measurement; the paired t test statistical analysis.
Results (1) established the pelvic and hip joint 3D model for the study of kinematics simulation and image measurement. The volume of femoral hip 164838mm3, 19853mm2 surface area, consisting of 8884 triangles and 4472 points; iliac bone volume 314552mm3, 59035mm2 surface area, consisting of 40366 triangles and 20245 points (2). The movement of the hip joint dynamic simulation showed that the linear motion of hip movement is not normal, but similar inverse function curve motion model. The slope of the curve decreases, tend to level DFPA tends to be a constant value. When acetabulum internal rotation showed a downward trend in the DFPA dynamic whole curve slope decreases and the curve is gradually decreased. The static simulation showed that the linear correlation of rotation angle DFPA and the acetabulum, regression equation and compute each extension angle. (3) the experimental group and the control group overall measurement results compared no significant difference (t= -1.983, P=0.067), its sensitivity is 80.95%.
Conclusion (1) the application of Mimics software to establish the pelvic and hip joint model 3D model, convenient operation, vivid appearance and accurate data, the distribution rules of one-sided.Mimics software is powerful, can be simulated by 3D model of pelvic fracture and hip joint motion, the simulation process in CT images can display real-time reverse, accurate imaging the measurement of the (2). Computer simulation and imaging of traumatic femoroacetabular impingement measurement was as follows: TileB2 rotary type of unstable pelvic fractures in acetabulum internal rotation, the rear hip over coverage, is a risk factor for the cause of the FAI; the TileB2 pelvic fractures lead to hip impingement syndrome stocks with the following two factors: the acetabulum internal rotation angle and hip joint range of motion. (3) the clinical application of health - patient abduction angle measurement by the difference of pelvis after fracture of acetabulum rotation angle and the actual situation. The sensitivity is high, which can accurately reflect the rotation angle of the acetabulum after pelvic fracture. That is to say, the experimental CT image measurement results are reciprocity with the clinical CT reading results, but the indications and operation requirements should be noted in clinical application.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R683.3;R816.8

【参考文献】