多排螺旋CT对髋关节撞击综合征的影像学研究
发布时间：2019-06-29 23:05
【摘要】：目的： 髋关节撞击综合征(femoroacetabular impingement, FAI)作为髋关节退行性骨关节炎的一种病因已经得到公认,在多排螺旋CT越来越广泛使用的今天,如何更好利用多排螺旋CT诊断FAI仍未有公认的标准。本研究以国内外现有研究为基础,重点分析多排螺旋CT在FAI诊断中的应用及临床意义,探讨利用多排螺旋CT平扫及后处理重建方法,了解髋关节撞击综合征解剖学及骨质异常,分析讨论不同后处理方式对FAI诊断的价值,并对FAI进行股骨头颈联合处α角、髋臼后倾形态学指标赤道边缘角EE角(Equatorial-edge angle)测量分析,旨在探讨多排螺旋CT检查中不同分型FAI的形态学指标在髋关节撞击综合征中的应用价值。此外,对FAI患者进行临床资料收集,对临床相关因素进行总结和分析,探讨FAI病因及临床因素对FAI疾病发生发展的影响。 材料与方法： 1.临床资料 搜集2010年1月至2012年5月髋关节疾患病人2475例,筛选出59例作为FAI组,所有患者均经临床检查髋关节撞击试验阳性,排除其他因素所致髋部、臀部或腹股沟疼痛,记录临床详细病史及体征。另选取20例因非股骨近端病变、无髋关节撞击综合征症状而接受下腹或双髋CT扫描的成年患者的CT容积数据作为对照组进行对比研究。 2.检查方法 FAI组及对照组均进行东芝AquillionCX64排螺旋CT扫描获取容积数据,再利用Aquarius影像工作站进行后处理,利用多种重建方法进行处理和观察。扫描采用仰卧位,患者身体中轴线与扫描床轴线平行,双下肢保持髌骨位置正中朝上 对筛选出的59例FAI患者进行髋关节撞击试验,查阅病人所有临床病历,并补充询问病史,记录病人性别、年龄、一般状态、既往史、发病诱因、运动习惯等临床资料。 3.图像分析 由两位高资历影像科医师和两位初级影像医师对FAI组的CT图像进行分析,得到统一意见,记录每个髋关节的解剖学异常征象,包括股骨头形态异常、头颈联合处异常、髋臼异常以及骨质硬化、关节面损伤、软骨下囊变、股骨颈疝窝等。选取股骨头颈联合处α角及髋臼EE角作为测量指标,正常对照组与FAI组均进行测量,由上述四位影像科医师测量,结果取四者平均值。 4.临床资料分析 由一名高年资医师及一名初级医师对FAI患者进行检查,确定髋关节试验为阳性,并对临床病史、症状及体征进行检查和确认,得出统一结论并记录；分析FAI患者发病的年龄、性别特点,总结临床发病诱因及统计症状部位、程度和特点,总结FAI发病的临床因素。 5.统计学方法 采用SPSS13.0统计学软件,计量资料数据用均数±标准差(x±s)表示,两组样本的比较采用两独立样本t检验进行；3组以上样本的数据比较采用单向方差分析(One-Way ANOVA),多重比较采用LSD法；率的比较采取Pearson卡方检验分析,多组计数资料的比较采取非参数检验方法中的Kruskal-Wallis H检验,双侧检验P＜0.05时,认为差异有统计学意义。 结果： FAI分为凸轮型、钳型、混合型,每型均存在不同程度解剖学异常及骨性异常征象；凸轮型FAI的解剖异常以股骨近端畸形、头颈间凹陷不足为主,钳型FAI的解剖异常以髋臼异常为主,包括髋臼后倾、深髋臼、前方或侧方髋臼的过度覆盖、髋臼的前突等；而混合型FAI的解剖异常可以同时兼有凸轮型、钳型的解剖异常；多排螺旋CT能很好显示关节周围骨质硬化、关节面损伤、软骨下囊变、股骨颈疝窝等异常骨质改变。对照组α角为41.826°±1.862°,FAI组为66.548°±9.169°,差异具有统计学意义(t=-14.903,P=0.000)；多重比较显示FAI组中以凸轮型的α角最大(71.851°±5.696°),钳型的α角最小(48.889°±3.364°全部P＜0.05)多重比较分析EE角显示除混合型FAI(16.729°±3.068°)和钳型FAI(16.386°±1.211°)间、FAI凸轮型(21.550°2.096°)与对照组(21.845°±2.814°)间EE角差异不具有统计学意义外(分别P=0.3234,P=-0.,7326),其余两两间EE角比较差异均具有显著统计学意义(全部P＜0.05) 统计分析显示20-40岁年龄段FAI发病患者最多(占总数75%),FAI组与对照组两组间患者性别无统计学差异,FAI组中凸轮型、钳型、混合型之间男女性别无统计学差异。本组59例FAI患者中,15例有大量或大幅度的髋部运动史,占25.4%；12例患者有直系亲属出现类似髋部症状,占20.3%。29例疼痛部位为髋部,占49.2%；15例以腹股沟疼痛为症状,占25.4%；12例以臀部疼痛为症状,占20.3%,3例以腰骶部疼痛为症状,占5.1%。 结论： 股骨近端和／或髋臼解剖结构的异常是FAI发病的重要因素,其原理认为异常的解剖结构减少了股骨颈和髋臼之间屈曲运动终末期的空间,导致髋臼与股骨颈产生异常碰撞,从而损伤髋臼盂唇及关节软骨,引起骨关节炎及关节退变。凸轮型FAI的解剖异常以股骨近端畸形为主,钳型FAI以髋臼解剖异常为主,FAI大部分情况是这两种机制的复合体,即为混合型。FAI诊断的形态学指标尚未有统一标准,α角是目前较公认的股骨头颈联合处形态异常的客观评价指标,利用多排螺旋CT经股骨颈斜轴位重建测量α角是角理想的测量方法,本组研究结果凸轮型FAI的α角最小为62.48°,α角诊断FAI的具体界定值尚待商榷。EE角是评价髋臼后倾的一个客观指标,同时也可以评估髋臼对股骨头覆盖程度,可以为诊断钳型及混合型FAI提供参考,本组研究中钳型EE角为16.386°±2.310°、混合型为15.729°±3.068°；目前EE角在FAI中还没有作为一个公认的测量指标应用在诊断工作中,测量量平面及测量方法仍存在分歧。 多排螺旋CT容积数据的多种重建方式,可以更加清楚的显示病变的关节及骨质内部的改变。利用多排螺旋CT的容积数据进行多种后处理,其中MPR、VR及SSD技术是最常用的后处理方式,对解剖学异常及细微骨质改变显示有独特优势,是诊断FAI较理想的方法。 诊断FAI须建立在影像学与临床密切结合的基础上,特别是与年龄不相符并且无陈旧性创伤病史的慢性髋关节区域疼痛、髋关节退行性变,如果影像学检查提示形态学存在FAI的风险因素,均应将FAI列入诊断范围。
[Abstract]:Purpose: The cause of hip joint impact syndrome (FAI) as a cause of the degenerative osteoarthritis of the hip has been recognized, and today, how to better utilize the multi-slice spiral CT to diagnose FAI has not yet been accepted. To study the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI, this study is based on the existing research at home and abroad, and discusses the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI. In this paper, the value of different post-treatment methods for FAI diagnosis was analyzed, and FAI was used to measure the angle of the joint of the head and neck of the femoral head. The purpose of this study is to explore the application of different types of FAI in multiple-slice spiral CT examination in the hip-impact syndrome. Value. In addition, the clinical data collection of FAI patients is performed, and the clinical-related factors are summarized and analyzed, and the causes of FAI and the shadow of the development of FAI diseases are discussed. in response to that material The method is as follows: 1. The clinical data collected 2475 cases of hip joint disease from January 2010 to May 2012, and 59 cases were selected as FAI group. All patients were tested positive by clinical examination of hip joint, and the hip and hip caused by other factors were excluded. Department or groin pain, record clinical Detailed medical history and signs.20 cases of adult patients receiving lower or double-hip CT scans for non-femoral proximal lesions and without hip-impingement syndrome were selected as controls group comparison and research 2. The method FAI and the control group were examined for volume data by the Toshiba Aquarion CX64-row spiral CT scan, and then the Aquarius image work station was used for post-treatment and a variety of methods were used. The reconstruction method is used for the treatment and observation. The scanning adopts the supine position, the central axis of the patient's body is parallel to the axis of the scanning bed, A total of 59 FAI patients screened out of the position of the lower limb in the position of the patella were subjected to hip impact test, and all the clinical medical records of the patient were consulted and the inquiry was supplemented. Ask for medical history, record patient's sex, age, general status, past history, hair the cause of the disease, the movement 3. The analysis of the CT images of the FAI group by two high-qualified and two primary medical practitioners in the image analysis to obtain a unified view to record the anatomical abnormalities of each hip joint. Including abnormal head shape, abnormal head and neck joint, acetabular abnormality, and bone hardening and closing. The joint of the head and neck of the femoral head and the angle of the acetabular EE were selected as the measurement index, and the normal control group and the FAI group were measured. Physician's measurement of the bit image department 4. The results are as follows:4. The clinical data analysis is performed by a high-year-age physician and a primary physician to the FAI patient, and the hip joint test is determined to be positive, and the clinical history, symptoms and signs are checked and confirmed to obtain a unified conclusion. The age and sex characteristics of the patients with FAI were analyzed and the causes of the clinical attack and the statistical symptoms were summarized. Location, degree, and The clinical factors of the incidence of FAI were summarized.5. The statistical method used the SPSS13.0 statistical software and the standard deviation (x% s) of the mean number of the data used for the measurement data. The comparison of the two groups was carried out by two independent samples t. The number of the above three samples One-Way ANOVA was used to compare the multiple comparisons with the LSD method; the Pearson chi-square test was used for the comparison of the rates, and the comparison of the multiple sets of counting data took the Kruskal-Wallis H in the non-quantitative test method. inspection, The results showed that FAI was divided into cam type, clamp type and mixed type, and there were different degree of anatomical and abnormal signs in each type. The anatomical abnormality of the cam type FAI was caused by the proximal femur. The shape and the depression of the head and neck are not the main, and the anatomic abnormality of the clamp type FAI is mainly due to the abnormal acetabulum, including the over-covering of the acetabulum, the deep acetabulum, the anterior or lateral acetabulum, the anterior projection of the acetabulum, and the like; and the anatomical abnormality of the mixed type FAI can both have both the cam type and the forceps-type anatomic abnormality; and the multiple rows The spiral CT can well show the periphery of the joint. The mean angle of the control group was 41.826 掳 and 1.862 掳, and the difference of the control group was 66.548 掳 and 9.169 掳, and the difference had statistical significance (t =-14.903, P = 0.000), and the multiple comparison showed that F In the AI group, the maximum angle of the cam type (71.851 掳 and 5.696 掳), the minimum angle of the clamp type (48.889 掳 and 3.364 掳 all P <0.05), and the multiple comparison and analysis of the EE angle showed that the FAI cam type (21.550 掳 2.096 掳) and the control group (21.845 掳 and 2.81 掳) were compared with the control group (21.45 掳 and 2.096 掳) and the clamp type FAI (16.386 掳 and 1.211 掳), and the FAI cam type (21.550 掳 2.096 掳) and the control group (21.845 掳 and 2.81 掳) 4 掳) E The difference of E-angle was not statistically significant (P = 0.3234, P =-0,7326, respectively), and the rest The difference of the two EE angles was statistically significant (all P <0.05). The statistical analysis showed that the maximum number of patients with FAI in the age group of 20 to 40 years (75% of the total), FA There was no statistical difference between the group I and the control group. There were no significant differences in the male and female sex between the cam type, the clamp type and the mixed type in the FAI group. Among the 59 cases of FAI,15 had a large or large number of hip motion history, accounting for 25.4%, and 12 patients had a direct relative to the hip symptom, accounting for 20.3%. The pain point in 29 cases was hip, accounting for 49.2%; 15 cases of groin pain, 25.4%;12 hips Department pain Conclusion: The abnormal structure of the proximal femur and/ or the acetabulum is an important factor in the pathogenesis of FAI. Reduced space in the end of flexion between the femoral neck and the acetabulum, resulting in the acetabular component There was an abnormal impact on the femoral neck, which damaged the labral and articular cartilage of the acetabulum, resulting in osteoarthritis and joint degeneration. The anatomic abnormality of the cam-type FAI was dominated by the proximal femur, and the clamp-type FA I was the main body of the acetabulum, and most of the FAI was the complex of the two mechanisms, which is the mixed type. The morphological index of the FAI diagnosis has not been unified, and the angle of incidence is the objective of the abnormal morphology of the joint of the femoral head at present. The evaluation index, using the multi-slice spiral CT to reconstruct the angle of the femoral neck through the oblique axis of the femoral neck, is an ideal method for measuring the angle, and the results of this study are convex. The minimum angle of the wheel-type FAI is 62.48 掳, and the specific definition of the angle-angle diagnostic FAI is still to be discussed. The EE angle is an objective index to evaluate the posterior gradient of the acetabulum. At the same time, it is also possible to evaluate the extent of the acetabulum to the head of the femoral head, which can be used as a reference for the diagnosis of the clamp type and the mixed type FAI. The angle is 16.386 掳 and 2.310 掳, and the mixed type is 15.729 掳 and 3.068 掳; the current EE angle is not yet available in FAI As a well-established measurement index, in the diagnosis, there are still differences in the measurement plane and the measuring method. The multi-slice spiral CT volume data can be used for many post-processing, in which MPR, VR and SSD technology are the most commonly used The diagnosis of FAI must be based on the close combination of the image and the clinical, in particular with the age that is not consistent with the age and the history of no old trauma. Regional pain in the area of the hip, the hip is backed out
【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】：2013
【分类号】：R274.9;R816.8
本文编号：2508193
[Abstract]:Purpose: The cause of hip joint impact syndrome (FAI) as a cause of the degenerative osteoarthritis of the hip has been recognized, and today, how to better utilize the multi-slice spiral CT to diagnose FAI has not yet been accepted. To study the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI, this study is based on the existing research at home and abroad, and discusses the application and clinical significance of multi-slice spiral CT in the diagnosis of FAI. In this paper, the value of different post-treatment methods for FAI diagnosis was analyzed, and FAI was used to measure the angle of the joint of the head and neck of the femoral head. The purpose of this study is to explore the application of different types of FAI in multiple-slice spiral CT examination in the hip-impact syndrome. Value. In addition, the clinical data collection of FAI patients is performed, and the clinical-related factors are summarized and analyzed, and the causes of FAI and the shadow of the development of FAI diseases are discussed. in response to that material The method is as follows: 1. The clinical data collected 2475 cases of hip joint disease from January 2010 to May 2012, and 59 cases were selected as FAI group. All patients were tested positive by clinical examination of hip joint, and the hip and hip caused by other factors were excluded. Department or groin pain, record clinical Detailed medical history and signs.20 cases of adult patients receiving lower or double-hip CT scans for non-femoral proximal lesions and without hip-impingement syndrome were selected as controls group comparison and research 2. The method FAI and the control group were examined for volume data by the Toshiba Aquarion CX64-row spiral CT scan, and then the Aquarius image work station was used for post-treatment and a variety of methods were used. The reconstruction method is used for the treatment and observation. The scanning adopts the supine position, the central axis of the patient's body is parallel to the axis of the scanning bed, A total of 59 FAI patients screened out of the position of the lower limb in the position of the patella were subjected to hip impact test, and all the clinical medical records of the patient were consulted and the inquiry was supplemented. Ask for medical history, record patient's sex, age, general status, past history, hair the cause of the disease, the movement 3. The analysis of the CT images of the FAI group by two high-qualified and two primary medical practitioners in the image analysis to obtain a unified view to record the anatomical abnormalities of each hip joint. Including abnormal head shape, abnormal head and neck joint, acetabular abnormality, and bone hardening and closing. The joint of the head and neck of the femoral head and the angle of the acetabular EE were selected as the measurement index, and the normal control group and the FAI group were measured. Physician's measurement of the bit image department 4. The results are as follows:4. The clinical data analysis is performed by a high-year-age physician and a primary physician to the FAI patient, and the hip joint test is determined to be positive, and the clinical history, symptoms and signs are checked and confirmed to obtain a unified conclusion. The age and sex characteristics of the patients with FAI were analyzed and the causes of the clinical attack and the statistical symptoms were summarized. Location, degree, and The clinical factors of the incidence of FAI were summarized.5. The statistical method used the SPSS13.0 statistical software and the standard deviation (x% s) of the mean number of the data used for the measurement data. The comparison of the two groups was carried out by two independent samples t. The number of the above three samples One-Way ANOVA was used to compare the multiple comparisons with the LSD method; the Pearson chi-square test was used for the comparison of the rates, and the comparison of the multiple sets of counting data took the Kruskal-Wallis H in the non-quantitative test method. inspection, The results showed that FAI was divided into cam type, clamp type and mixed type, and there were different degree of anatomical and abnormal signs in each type. The anatomical abnormality of the cam type FAI was caused by the proximal femur. The shape and the depression of the head and neck are not the main, and the anatomic abnormality of the clamp type FAI is mainly due to the abnormal acetabulum, including the over-covering of the acetabulum, the deep acetabulum, the anterior or lateral acetabulum, the anterior projection of the acetabulum, and the like; and the anatomical abnormality of the mixed type FAI can both have both the cam type and the forceps-type anatomic abnormality; and the multiple rows The spiral CT can well show the periphery of the joint. The mean angle of the control group was 41.826 掳 and 1.862 掳, and the difference of the control group was 66.548 掳 and 9.169 掳, and the difference had statistical significance (t =-14.903, P = 0.000), and the multiple comparison showed that F In the AI group, the maximum angle of the cam type (71.851 掳 and 5.696 掳), the minimum angle of the clamp type (48.889 掳 and 3.364 掳 all P <0.05), and the multiple comparison and analysis of the EE angle showed that the FAI cam type (21.550 掳 2.096 掳) and the control group (21.845 掳 and 2.81 掳) were compared with the control group (21.45 掳 and 2.096 掳) and the clamp type FAI (16.386 掳 and 1.211 掳), and the FAI cam type (21.550 掳 2.096 掳) and the control group (21.845 掳 and 2.81 掳) 4 掳) E The difference of E-angle was not statistically significant (P = 0.3234, P =-0,7326, respectively), and the rest The difference of the two EE angles was statistically significant (all P <0.05). The statistical analysis showed that the maximum number of patients with FAI in the age group of 20 to 40 years (75% of the total), FA There was no statistical difference between the group I and the control group. There were no significant differences in the male and female sex between the cam type, the clamp type and the mixed type in the FAI group. Among the 59 cases of FAI,15 had a large or large number of hip motion history, accounting for 25.4%, and 12 patients had a direct relative to the hip symptom, accounting for 20.3%. The pain point in 29 cases was hip, accounting for 49.2%; 15 cases of groin pain, 25.4%;12 hips Department pain Conclusion: The abnormal structure of the proximal femur and/ or the acetabulum is an important factor in the pathogenesis of FAI. Reduced space in the end of flexion between the femoral neck and the acetabulum, resulting in the acetabular component There was an abnormal impact on the femoral neck, which damaged the labral and articular cartilage of the acetabulum, resulting in osteoarthritis and joint degeneration. The anatomic abnormality of the cam-type FAI was dominated by the proximal femur, and the clamp-type FA I was the main body of the acetabulum, and most of the FAI was the complex of the two mechanisms, which is the mixed type. The morphological index of the FAI diagnosis has not been unified, and the angle of incidence is the objective of the abnormal morphology of the joint of the femoral head at present. The evaluation index, using the multi-slice spiral CT to reconstruct the angle of the femoral neck through the oblique axis of the femoral neck, is an ideal method for measuring the angle, and the results of this study are convex. The minimum angle of the wheel-type FAI is 62.48 掳, and the specific definition of the angle-angle diagnostic FAI is still to be discussed. The EE angle is an objective index to evaluate the posterior gradient of the acetabulum. At the same time, it is also possible to evaluate the extent of the acetabulum to the head of the femoral head, which can be used as a reference for the diagnosis of the clamp type and the mixed type FAI. The angle is 16.386 掳 and 2.310 掳, and the mixed type is 15.729 掳 and 3.068 掳; the current EE angle is not yet available in FAI As a well-established measurement index, in the diagnosis, there are still differences in the measurement plane and the measuring method. The multi-slice spiral CT volume data can be used for many post-processing, in which MPR, VR and SSD technology are the most commonly used The diagnosis of FAI must be based on the close combination of the image and the clinical, in particular with the age that is not consistent with the age and the history of no old trauma. Regional pain in the area of the hip, the hip is backed out
【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】：2013
【分类号】：R274.9;R816.8
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