【作者】 胡荣慧；

【导师】 巫北海；

【作者基本信息】 第三军医大学 ， 影像医学与核医学， 2008， 博士

【摘要】 第一部份髋关节薄层断面解剖与CT、MRI图像的对照研究目的:探讨髋关节区各结构的连续薄层断面形态规律及CT, MRI表现。材料和方法:1)选取经10%福尔马林浸泡的成人尸体盆腔段标本3例全部行CT和MRI扫描;2)然后利用可视化人体数据采集技术,分别获得层厚0.5mm的髋关节区横断位、冠状位、斜冠位和矢状面连续冰冻断面标本各一套。3)观察髋关节解剖断面主要结构与相应CT、MRI图像的对应关系,寻找目标结构最佳显示方位。结果:获得髋关节区横断位、冠状位、矢状面和斜冠位连续断面可视化数据集各一套(层厚0.5mm),各断面能清楚显示髋关节骨骼、韧带、肌肉、神经、血管等结构及其毗邻,并与相应CT、MRI图像具有良好的对应关系。结论:薄层断面解剖与CT, MRI有良好的对应关系,薄层断面切片能良好显示髋关节复杂结构及毗邻,结合CT和MRI进行对照研究,可深入了解髋关节复杂结构的连续薄层断面形态规律,为髋关节区病变的诊断和治疗提供了形态学依据。第二部份髋关节的可视化及CT三维重建目的:建立髋关节区三维可视化数字解剖模型,评价CT三维重建在髋关节区的应用价值。材料和方法:1)选取中国首套女性可视化人体数据集(CVH-2)骨盆段图像数据,运用连续图像分割软件,分别对髋关节目标结构进行结构数据的分割与提取,并在SGI工作站和个人计算机上完成髋关节可视化重建。2)选取20例行髋关节CT扫描的患者和30例行腹主动脉至下肢动脉CT动脉造影(Computed Tomography Angiography CTA)的患者,进行三维重建观察并与可视化解剖模型进行比较。结果:可视化解剖模型对研究髋关节骨质结构和软组织结构具有十分明显的优越性,能在三维空间位置上可任意重组、切割、旋转观察髋关节区各结构,建立人体髋关节可视化解剖模型,为髋关节数字化解剖学的开展提供可视化教学平台。CT三维重建能清楚显示髋关节骨折、脱位的情况,髋关节CT动脉造影能清楚显示髋关节周围动脉的生理情况和病理信息,其中尤其以容积再现法显示为佳,CT三维重建有助于外科个体化手术方案的制定。结论:可视化模型对研究髋关节区复杂的解剖结构具有十分明显的优越性,能真实反映髋关节各结构的相互关系及毗邻。CT三维重建对髋关节骨骼及周围血管病变的诊断和治疗具有重要价值。第三部份髋关节的CT活体形态测量及临床价值探讨目的:通过CT对髋关节的测量,为髋关节区病变的影像学诊断提供参考。材料和方法:选取行髋关节CT检查者的108例患者,正常成人髋关节50例,单侧发育性髋关节脱位(Developmental Dysplasia of the Hip, DDH) 20例,单侧股骨颈骨折38例。在横轴位、冠状位、斜冠位和三维图像上测量颈干角、外倾角、前后髋臼角、前后中心边缘角等参数,比较在冠状面、斜冠面和三维图像所测颈干角,比较DDH患儿双侧髋关节颈干角,比较以扫描床和人体冠状面为参照面所测的数据,并进行统计学分析。结果:正常成人组颈干角在冠状位、斜冠位和3D CT上测量分别为134.70°±6.99°,128.45°±4.40°,126.28°±4.63°,冠状位和斜面冠位之间、冠状位和三维测量颈干角之间差异有显著性(P<0.01)、斜面冠位和三维测量颈干角之间差别无统计学意义(P>0.05)。小儿先天性髋关节脱位组双侧颈干角在斜冠位的测量值,正常侧134.7°±6.99°,脱位侧146.10°±2.02°,二者之间差异有显著性(P<0.01)。分别以扫描床和人体冠状面为参照面所测的数据二者之间有显著性(P<0.01)。结论:髋关节区CT活体形态测量有助于了解髋关节区复杂的解剖结构,斜冠面和人体冠状面概念的引入在髋关节活体形态CT测量具有重要价值,为髋关节区病变的诊断和治疗提供确切的量化指标。更多还原

【Abstract】 PartⅠThe control study of hip joint: thin sectional anatomy with CT and MRIObjective: To study the thin sectional anatomy and CT and MR imaging of hip joint.Materials and methods: 1)Three adult cavitas pelvis specimens were selected and soaked in formalin(10%), each specimen was imaged with CT and MRI. 2)Visible human technique was used to collect human hip joint data. Four anatomical atlas of thin serial section images of hip joint were obtained, including one transverse section, one coronal, one oblique coronal and one sagittal section. Every serial thin sections of hip joint were observed and were compared with correspond the images of CT and MRI to search the best reveal direction of the object structrues.Results: Serial sections of 0.5mm slice thickness for the axial, coronal, oblique coronal and sagittal levels of hip joint with frozen section technique were obtained. The resulting sections demonstrated excellent distinction of bone and joint, ligaments, nerves and blood vessels of hip joint and their adjacent structures. We found a good overall correlation between sections and images of CT an MRI.Conclusions: There is a good corresponding relation in slice dissection and CT and MRI. In combination with CT and MRI, serial thin sections of hip joint offers a better understanding of the complex anatomy of hip joint and provides a morphological basis for imaging diagnosis and therapy of hip joint.PartⅡVisualization and CT Three Diamensions Reconstruction of Human Hip JointObjective: To build digitized visible anatomical model and to evaluate the value of CT three dimensional (3D CT) reconstruction of hip joint.Materials and methods: 1)The pelvis images data of the First Female Chinese Visible Human Data Set were selected. After being recognized and segmented by the Photoshop software, the target objects of hip joint were visualized reconstructed on SGI workstation and personal computer with photo segment software. 2)20 cases complained hip joint problem scaned with CT and 30 cases who had performed computed tomography angiography (CTA) from aorta to artery of lower extremity were selected. Three diamensions reconstruction of hip joint bone and artery were observed and were compared with the digitized visible anatomical model.Results: The digitized visible anatomical model demonstrated bone and soft structures of hip joint very well, the structures could be displayed singly or in small groups, could be cut freely and continuously rotated in 3D space. The creation of visible anatomical hip joint model can be used for the digital anatomy teaching. 3D CT reconstruction could clearly delineate the fracture and dislocation of hip joint, and computed tomography angiography can reveal the physiological and pathological information of hip joint artery, especially with volume rendering technique. 3D CT can help make surgical individualization planning for the hip joint.Conclusions: The 3D digitized visible anatomical model has an obvious advantage in the study of the complex anatomy of hip joint and offer unique insights to it. It can reveal the actual adjacent relation of hip joint.3D CT reconstruction has important value in diagnosis and treatment to bone and artery diseases of hip joint.PartⅢCT Measurement of Hip Joint in Vivo and clinical valueObjective: To provide the criterion for imaging diagnosis of hip joint through CT measurement.Materials and methods: 108 cases who had performed CT scan were selected. 50 adults′hip joints have no hip structural disease, and 20 cases have unilateral developmental dysplasia of the hip(DDH), and 38 cases have unilateral femoral neck fracture. Parameters include collodiaphyseal angle, angle of anteversion angle of declination,proso-angulus acetabularis and post-angulus acetabularis,proso-center edge angle and post- center edge angle were measured in the images in transverse, coronal, oblique coronal and sagittal plane. Compare the collodiaphyseal angle that measured in coronal, oblique coronal plane and 3D CT. Compare the two hip joint collodiaphyseal angle that measured in DDH. Compare the datum that measured in accordance with scan bed and the body coronal plane. The datum was analyzed statistically.Results: the collodiaphyseal angle that measured in coronal , oblique coronal plane and 3D CT are respectively 134.7°±6.99°,128.45°±4.40°,126.28°±4.63°, There were significant difference between coronal and oblique coronal plane, coronal and 3D CT (P<0.01). There was not significant difference between oblique coronal plane and 3D CT (P>0.05). Compare the two hip joint collodiaphyseal angle that measured in DDH, Compare the data that measured in accordance with scan bed and the human body coronal plane, There were significant difference (P<0.01).Conclusions: CT measurement of hip joint in vivo aids us to understand the complex anatomy of hip joint. The concept of oblique coronal plane and the human body coronal plane have important value in measurement of hip joint in vivo. it provides exact quantization index in the diagnosis and treatment of hip joint pathological changes.更多还原