基于三维CT诊断分析系统的股骨头坏死分型及坏死塌陷预测的前瞻性研究

发布时间：2018-05-15 09:27

本文选题：CT + 三维重建　；参考：《浙江中医药大学》2013年硕士论文

【摘要】：目的：依据三维CT图像数据,在股骨头三维CT诊断分析系统中重构出三维股骨头坏死模型,直观化确定坏死的部位,测出坏死病灶的体积并与股骨头坏死大体标本的体积比较,探讨其准确性及临床实际意义。方法：38例(53髋)股骨头坏死患者,男26例,女12例,平均年龄38.5岁(32-58岁)。激素性坏死17例(28髋),酒精性坏死14例(17髋),特发性坏死4例((4髋),创伤性坏死3例(4髋)。ARCO分期：Ⅱ期11髋, Ⅲ期30髋,Ⅳ期12髋。所有患者每6个月进行一次三维CT检查。在行全髋关节置换术术前再次进行三维CT扫描,获得髋关节三维CT图像的DICOM格式数据。利用白行研发的股骨头坏死测量软件将图像导入,提取出股骨头及其坏死区域的轮廓。并直接读取股骨头及其坏死组织区域的体积及两者之间的百分比、坏死占各个象限的百分比。临床随访以股骨头塌陷作为观察的终点,对未塌陷的患者至少观察24个月。使用采用SPSS17.0统计软件对重建股骨头与真实股骨头及坏死体积的差异进行t检验,选择直线相关和回归分析分析各参数与塌陷的相关性。对行全骸关节置换术的患者,将术后取出的股骨头进行大体测量。使用移水法测出大体股骨头及其坏死病灶的体积,与计算机所得结果相比较,进行统计学分析。结果：重构的三维股骨头模型上可见股骨头坏死区域多位于股骨头的外上方,与大体股骨头坏死病灶的位置符合。42髋通过软件测得整个股骨头的体积为48.03±4.82cm3(范围为36.42-61.38cm3),坏死病灶的体积为20.63±6.54cm3(范围为10.52-38.94cm3)。股骨头坏死病灶的体积与整个股骨头的体积比为42.6%±11.78。大体测得整个股骨头的平均体积为(48.66±4.42)cm3,股骨头坏死区域的平均体积为(20.7±5.5)cm3(范围为10～39cm3)。股骨头坏死区域的体积与整个股骨头的体积比为42.5%±11.87。实体测量的体积值比软件测量的体积值稍略大,两者相比整个股骨头体积约大1.23%,股骨头坏死区域体积约大1.97%。两者测量的体积差,整个股骨头的为0.43±0.7cm3,在统计学上无显著性差别(配对t=-1.515,P0.05)；股骨头坏死病灶的体积差为0.97±0.45cm3,在统计学上也无显著性差别(配对t=-1.523,P0.05)。随访的38例(53髋)中有42髋发生了塌陷,平均股骨头坏死体积比为35.8%±12.5,未塌陷的11髋,平均股骨头坏死体积比为16.35%±5.42；塌陷的股骨头中,t1象限坏死体积占整个股骨头坏死体积的比例为10.3%±7.9,t2象限为11.3%±6.8,t3象限为6.3%±7.9,t4象限为22.3%±8.7,t5象限为23.5%±11.7,t6象限为12.3%±8.1,t7象限为3.6%±2.6, t8象限为4.1%±5.3,t9象限为2.7.%±6.9, t10象限为1.1%±2.4, t11象限为1.3%±3.3, t12象限为1.1%±1.6；在未塌陷的股骨头中,t1象限坏死体积占整个股骨头坏死体积的比例为27.3%±10.8,t2象限为23.5%±11.7,t3象限为13.6%±7.9, t4象限为11.3%±6.9,t5象限为12.3.%±7.8,t6象限为6.3%±7.9, t7象限为3.6%±2.6, t8象限为4.1%±5.3,t9象限为2.7.%±6.9, t10象限为0.1%±2.4, tll象限为0.3%±3.3,t12象限为0.1%±1.6。相关回归分析结果表明,股骨头坏死体积比(v01)与塌陷密切相关,p0.05,坏死灶在t4,t5及t6象限的分布比例也与股骨头塌陷密切相关,p0.05。当坏死病灶体积大于35%时,股骨头坏死的塌陷率高达76%以上。结论：CT图像计算机三维重建可以精确地重构出股骨头坏死的三维模型,可以帮助临床骨科医师直观、立体化地理解股骨头坏死病灶的形状和位置。能够准确地计算坏死病灶的体积,其结果可信,与大体测量相符合。股骨头坏死病灶体积的大小、坏死体积的分布位置与股骨头塌陷的危险性密切相关。回归分析结果表明股骨头坏死体积比在预测股骨头塌陷中起重要作用,当坏死体积比大于35%,即有塌陷的危险。股骨头坏死的分布在小范围坏死中对预测塌陷起重要作用,当坏死体积比小于20%,如果坏死分布在第t4-t6象限(股骨头前外上方),股骨头有塌陷的潜在危险。
[Abstract]:Objective: according to the three-dimensional CT image data, three-dimensional femoral head necrosis model was reconstructed in the three-dimensional CT diagnosis and analysis system of femoral head, and the necrotic site was determined intuitively, the volume of the necrotic focus was measured and compared with the volume of the gross necrosis of the femoral head, the accuracy and the practical significance of the bed were discussed.
Methods: 38 cases (53 hips) with avascular necrosis of the femoral head, 26 men and 12 women, with an average age of 38.5 years (32-58 years), 17 cases of steroid necrosis (28 hips), 14 cases of alcoholic necrosis (17 hips), 4 idiopathic necrosis (4 hips) and.ARCO staging of traumatic necrosis (HIPS): stage II hip, stage III hip, and IV hip. All patients performed a three dimensional CT examination every month. Three dimensional CT scan was performed again before total hip replacement to obtain the DICOM format data of the 3D CT image of the hip joint. The image was introduced into the femoral head and its necrotic region by using the femoral head necrosis measurement software developed in white. The percentage of each quadrant, necrosis was used as the end point of the observation of the femoral head collapse, and at least 24 months were observed in the patients without the collapse. The SPSS17.0 statistical software was used to test the difference between the femoral head and the real femoral head and the volume of the necrosis, and the parameters and the collapse were analyzed by linear correlation and regression analysis. The total femoral head and its necrotic focus were measured by the method of water transfer, and the results were compared with the results of the computer.
Results: the femoral head necrosis area of the reconstructed femoral head was found in the upper part of the femoral head, and the size of the whole femoral head was 48.03 + 4.82cm3 (range 36.42-61.38cm3), and the volume of the necrotic foci was 20.63 + 6.54cm3 (range 10.52-38.94cm3). The volume ratio of the necrosis of the femoral head to the whole femoral head is 42.6% + 11.78., and the average volume of the whole femoral head is (48.66 + 4.42) cm3, the average volume of the necrosis area of the femoral head is (20.7 + 5.5) cm3 (range 10 to 39cm3). The volume ratio of the necrosis area of the femoral head with the whole femoral head is 42.5% + 11.87. solid measurements. The volume value of the volume is slightly larger than that measured by the software. The volume of the femoral head volume is about 1.23% and the volume of the femoral head necrosis area is about 1.97%.. The volume of the femoral head is about 0.43 + 0.7cm3, and there is no significant difference in Statistics (paired t=-1.515, P0.05); the volume difference of the necrosis of the femoral head is 0.97 + 0.45. Cm3, there was no statistically significant difference (paired t=-1.523, P0.05). In 38 cases (53 hips), 42 of the hips were collapsed, the average necrosis volume ratio of the femoral head was 35.8% + 12.5, the unsubsided 11 hips, the mean femoral head necrosis volume ratio was 16.35% + 5.42, and the T1 quadrant necrosis volume accounted for the whole femoral head necrosis volume in the collapsed femur head. The ratio of the T2 quadrant is 11.3% + 6.8, the T3 quadrant is 6.3% + 7.9, the T4 quadrant is 22.3% + 8.7, the T5 quadrant is 23.5% + 11.7, the T6 quadrant is 12.3% + 8.1, the T7 quadrant is 3.6% + 2.6, the T8 quadrant is + 7.9, the T9 quadrant is 2.7.% +. The proportion of the necrotic volume of the whole femoral head is 27.3% + 10.8, the T2 quadrant is 23.5% + 11.7, the T3 quadrant is 13.6% + 7.9, the T4 quadrant is 11.3% + 6.9, the T5 quadrant is 12.3.% + 7.8, the T6 quadrant is 6.3% +, and the T7 quadrant is 3.6% + 2.6, the T8 quadrant is 6.9, and the T9 quadrant is 2.7.% +. The results of 0.1% + 1.6. correlation regression analysis showed that the volume ratio of necrosis of the femoral head (V01) was closely related to the collapse. P0.05, the distribution ratio of the necrotic foci in T4, T5 and T6 quadrants was closely related to the collapse of the femoral head, and the collapse rate of the necrosis of the femoral head was over 76% when the necrotic focus volume was greater than 35% in p0.05..
Conclusion: the three-dimensional reconstruction of the CT image can accurately reconstruct the three-dimensional model of the necrosis of the femoral head. It can help the clinical department of orthopedics doctors to intuitively understand the shape and position of the necrosis of the femoral head, and can accurately calculate the volume of the necrotic focus. The results are reliable, and the volume of the necrosis of the femoral head is in accordance with the gross measurement. The size of the necrotic volume is closely related to the risk of the collapse of the femoral head. Regression analysis shows that the volume ratio of the necrosis of the femoral head plays an important role in predicting the collapse of the femoral head, when the necrotic volume ratio is greater than 35%, that is, the risk of collapse. If the necrosis volume ratio is less than 20%, if the necrosis is distributed in the T4-T6 quadrant (above and outside the femoral head), the femoral head will have potential risk of collapse.

【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8

【参考文献】