本文關(guān)鍵詞： 股骨近端 解剖參數(shù) 假體設(shè)計(jì)　出處：《吉林大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：測(cè)量東北地區(qū)成人股骨近端解剖參數(shù)，用以指導(dǎo)關(guān)節(jié)置換的術(shù)前計(jì)劃和假體選擇，同時(shí)為設(shè)計(jì)更符合國(guó)人解剖特點(diǎn)的人工髖關(guān)節(jié)假體提供數(shù)據(jù)支持。 方法：在吉林大學(xué)中日聯(lián)誼醫(yī)院影像系統(tǒng)Centricity RIS/PACS CE中，隨機(jī)選取成人標(biāo)準(zhǔn)雙髖正位x線(xiàn)平片，男女各50例。每例x線(xiàn)片均使用Centricity RIS/PACS CE直接測(cè)量股骨近端下列參數(shù)：股骨頭直徑，頸干角，股骨頸長(zhǎng)，偏心距，大粗隆高點(diǎn)高于股骨頭旋轉(zhuǎn)中心的高度，股骨距區(qū)域皮質(zhì)弧度，小粗隆高點(diǎn)水平股骨髓腔內(nèi)徑（Dt），小粗隆高點(diǎn)水平遠(yuǎn)端20mm處髓腔內(nèi)徑（Dt-20），小粗隆高點(diǎn)水平近端20mm（Dt+20）和近端10mm（Dt+10）髓腔內(nèi)徑，股骨峽部髓腔內(nèi)徑（Di），峽部水平到小粗隆高點(diǎn)水平的垂直距離（H），以及由上述各參數(shù)處理后得出的髓腔開(kāi)口指數(shù)CFI（Dt+20/Di），干骺端髓腔開(kāi)口指數(shù)MCFI1（Dt+20/Dt-20），以及干骺端髓腔開(kāi)口指數(shù)MCFI2(Dt+10/Dt-20)。直接測(cè)量的數(shù)據(jù)經(jīng)軟件校正系數(shù)校正后，運(yùn)用sPSS13.0進(jìn)行統(tǒng)計(jì)學(xué)分析，所有數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差表示，男女之間行兩獨(dú)立樣本t檢驗(yàn)，左右之間行配對(duì)t檢驗(yàn)，各參數(shù)之間行相關(guān)性分析。并通過(guò)樣本均數(shù)估計(jì)總體均數(shù)的方法將數(shù)據(jù)結(jié)果與國(guó)內(nèi)外其他研究進(jìn)行比較。 結(jié)果：股骨頭直徑為48.64±4.09mm，頸干角為126.4±4.6°，股骨頸長(zhǎng)為51.37±5.69mm，偏心距為41.29±5.73mm，大粗隆尖高于股骨頭旋轉(zhuǎn)中心的高度為7.86±4.51mm，股骨距區(qū)域內(nèi)側(cè)皮質(zhì)弧度為0.49±0.17rad，小粗隆高點(diǎn)水平近端20mm處髓腔內(nèi)徑為43.83±4.90mm，近端10mm處股骨髓腔內(nèi)徑為33.69±4.12mm，小粗隆高點(diǎn)水平股骨髓腔內(nèi)徑為27.22±3.53mm，遠(yuǎn)端20mm處股骨髓腔內(nèi)徑為19.58±2.61mm，股骨峽部髓腔內(nèi)徑為10.92±1.60mm，峽部水平到小粗隆高點(diǎn)水平的距離為98.97±14.82mm，髓腔開(kāi)口指數(shù)CFI為4.10±0.73，干骺端髓腔開(kāi)口指數(shù)MCFI1為2.26±0.21，，MCFI2為1.73±0.14。各參數(shù)左右側(cè)比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）；除頸干角、大粗隆最高點(diǎn)與旋轉(zhuǎn)中心的高度差、股骨距區(qū)域皮質(zhì)弧度、CFI四項(xiàng)參數(shù)外，其余參數(shù)男女之間差異有統(tǒng)計(jì)學(xué)意義（p0.05），女性CFI4.7者所占比率（24%）高于男性（14%）。偏心距、Dt-20、Di、MCFI1、CFI等五項(xiàng)參數(shù)在不同年齡組間差異有統(tǒng)計(jì)學(xué)意義（p0.05）。與國(guó)內(nèi)其他地區(qū)及國(guó)外多個(gè)研究結(jié)果比較，多項(xiàng)參數(shù)間存在顯著差異（p0.05）。 結(jié)論： 1、東北地區(qū)成人股骨近端髓腔形態(tài)多項(xiàng)參數(shù)在左右側(cè)無(wú)顯著差異，不同年齡組之間、男女性別之間有顯著差異。與國(guó)內(nèi)北京、江蘇、湖南等地區(qū)的部分研究間多項(xiàng)參數(shù)差異存在統(tǒng)計(jì)學(xué)意義。與國(guó)外比較多有顯著差異。 2、股骨近端髓腔形態(tài)多項(xiàng)參數(shù)間具有相關(guān)關(guān)系，干骺端髓腔隨著年齡增大而呈現(xiàn)“煙囪型”的比例更大。女性較男性而言，呈現(xiàn)“漏斗型”的比例更大。 3、股骨距區(qū)域內(nèi)側(cè)皮質(zhì)內(nèi)緣的弧度可以作為股骨柄假體設(shè)計(jì)和選擇的一個(gè)參數(shù)。 4、大粗隆高點(diǎn)與股骨頭旋轉(zhuǎn)中心不在一個(gè)水平面，多數(shù)高于旋轉(zhuǎn)中心且平均高度差不到1cm，可以作為術(shù)中控制下肢長(zhǎng)度的參考。 5、應(yīng)設(shè)計(jì)符合國(guó)人解剖特點(diǎn)的假體。在進(jìn)行假體設(shè)計(jì)和術(shù)中假體置入時(shí)應(yīng)考慮國(guó)人股骨近端髓腔形態(tài)特點(diǎn)。
[Abstract]:Objective: to measure the anatomical parameters of proximal femur in adults in Northeast China, so as to guide preoperative planning and prosthesis selection for joint replacement, and to provide data support for designing hip prosthesis which is more suitable for Chinese anatomy.
Methods: in the imaging system of Centricity RIS/PACS in China Japan Union Hospital of Jilin University in CE, randomly selected adult standard double hip anteroposterior X-ray film, 50 cases of male and female. In each case the X-ray was used Centricity RIS/PACS CE to directly measure the following parameters: proximal femoral head diameter, neck shaft angle, femoral neck length, eccentricity. The greater trochanter high above the center of rotation of the femoral head height, femur cortical area radian, the lesser trochanter high level of femoral medullary cavity diameter (Dt), the lesser trochanter high level 20mm distal medullary cavity diameter (Dt-20), the lesser trochanter high level proximal 20mm (Dt+20) and proximal 10mm (Dt+10) medullary cavity diameter, femoral isthmus diameter (Di), isthmus level vertical distance to the lesser trochanter high level (H), and the medullary cavity of the above parameters is obtained after the treatment by the opening of the CFI index (Dt+20/Di), metaphyseal medullary cavity opening refers to the number of MCFI1 (Dt+20/Dt-20), and metaphyseal marrow cavity An index of MCFI2 (Dt+10/Dt-20). The data of the direct measurement of the software correction coefficient after correction, using sPSS13.0 for statistical analysis, all data with the mean standard deviation of that between men and women for two independent samples t test, or between the paired t test, correlation analysis performed between the parameters. And through the sample number estimation method the overall mean of the data results were compared with other studies at home and abroad.
Results: the femoral head diameter was 48.64 + 4.09mm, 126.4 + collodiaphyseal angle of 4.6 degrees, the long neck of the femur was 51.37 + 5.69mm, 41.29 + 5.73mm eccentricity, the greater trochanter height of the toe is higher than the center of rotation of the femoral head was 7.86 + 4.51mm, the calcar region of medial cortex radian was 0.49 + 0.17rad, the lesser trochanter high level of 20mm in the proximal medullary cavity diameter was 43.83 + 4.90mm, 10mm proximal femoral bone marrow cavity diameter was 33.69 + 4.12mm, high level of the lesser trochanter femoral medullary cavity diameter was 27.22 + 3.53mm, 20mm distal femoral marrow cavity diameter was 19.58 + 2.61mm, femoral isthmus diameter was 10.92 + 1.60mm, isthmus to the level of the lesser trochanter high level distance was 98.97 + 14.82mm, canal flare index CFI was 4.10 + 0.73, metaphyseal medullary cavity opening index MCFI1 was 2.26 + 0.21, 1.73 + MCFI2 0.14. parameters of left and right sides showed no significant difference (P0.05); the collodiaphyseal angle, the greater trochanter the highest point The height difference between the center of rotation of the femur cortical region arc, CFI four parameters, there were significant differences between men and women of other parameters (P0.05) CFI4.7, female ratio (24%) than men (14%). Dt-20, Di, eccentricity, MCFI1, the five parameters of CFI in different age differences between the groups was statistically significant (P0.05). Compared with other regions in the country and overseas research results, there are significant differences between the parameters (P0.05).
Conclusion:
1, the northeast region of adult proximal femoral medullary cavity shape parameters had no significant difference in the left and right side, between different age groups, there are significant differences between male and female. With the domestic Beijing, Jiangsu, was statistically significant difference between the parameters of part of the Hunan area between abroad and more. There are significant differences.
2, there was a correlation between the parameters of the proximal femoral medullary cavity and many parameters. The proportion of the metaphyseal pulp cavity increased with age. The proportion of the "funnel type" of the female was greater than that of the male.
3, a parameter of the calcar region of medial cortex inner radian can be used as the design and selection of femoral prosthesis.
4, the greater trochanter height and the femoral head rotation center are not on a horizontal plane, most of which are higher than the center of rotation, and the average height difference is less than 1cm, which can be used as a reference to control the length of the lower extremities during operation.
5, a prosthesis should be designed in accordance with the characteristics of the national anatomy. The morphological characteristics of the proximal femoral medullary cavity should be taken into consideration in the design of prosthesis and the implantation of prosthesis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R318.17

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