【作者】 许鹏；

【导师】 李彦林；

【作者基本信息】 昆明医科大学 ， 外科学， 2012， 硕士

【摘要】 第一部分、MRI影像下股骨髁间窝三维数字化解剖与实体解剖测量值的对比研究[目的]随着计算机辅助技术和数字化解剖学的发展,通过建立股骨髁间窝的数字化解剖模型,可为髁间窝的解剖学研究提供新的路径。故本研究基于MRI影像下建立尸体股骨髁间窝三维数字化模型测量其解剖数据,并与尸体股骨髁间窝实体解剖数据比较,探讨基于MRI影像下重建股骨髁间窝三维数字化模型的准确性及可靠性。[方法]1、对18侧男性、14侧女性新鲜冰冻膝关节尸体标本进行MR扫描获取二维图像。把MR二维图像导入Mimics软件中对股骨髁间窝进行三维重建,分别测量三维数字化模型的髁间窝宽度(ICW)、两髁宽度(ECW)、髁间窝高度(ICH)、髁间窝顶的宽度(BLL)、股骨外髁的宽度(LCW)、股骨内髁的宽度(MCW)、外侧髁的前后径(SLLC)、内侧髁的前后径(SLMC)、股骨外髁倾角(ALC)、股骨内髁倾角(AMC),以上数据为三维重建组。2、对18侧男性、14侧女性新鲜冰冻膝关节尸体标本进行实体解剖,分别测量实体股骨髁间窝宽度(ICW)、两髁宽度(ECW)、髁间窝高度(ICH)、髁间窝顶的宽度(BLL)、股骨外髁的宽度(LCW)、股骨内髁的宽度(MCW)、外侧髁的前后径(SLLC)、内侧髁的前后径(SLMC)、股骨外髁倾角(ALC)、股骨内髁倾角(AMC),以上数据为实体组。3、运用SPSS Statistics17.0统计学软件进行分析,两组数据及比值均数比较采用配对样本t检验,以α=0.05作为检验标准。[结果]1、男性三维重建组和实体组的ECW, ICH. BLL、LCW、MCW、 SLLC、SLMC、ALC、AMC比较均无差异(p>0.05)、髁间窝指数无差异(p>0.05)。2、女性三维重建组和实体组的ICW、ECW、ICH、BLL、LCW、MCW、 SLLC、SLMC、ALC. AMC比较均无差异(p>0.05)、髁间窝指数无差异(p>0.05)。[结论]基于MRI影像下股骨髁间窝的三维数字化模型能够准确反映实体标本解剖信息,可用于正常人股骨髁间窝的解剖学研究,并对髁间窝相关疾病诊治、交叉韧带重建术具有重要的指导意义。第二部分、基于MRI影像下股骨髁间窝的数字化解剖学研究[目的]随着计算机辅助技术和数字化解剖学的发展,通过建立股骨髁间窝的数字化解剖模型并对其进行解剖学研究成为重要的研究方法之一,为髁间窝的解剖学研究提供了新的路径。通过基于健康成人膝关节MR二维影像对股骨髁间窝的三维重建,研究股骨髁间窝的解剖形态,以及对比其在性别方面和同体左右侧的差别,探讨虚拟化髁间窝成形术的临床运用价值。[方法]1、对15例男性、15例女性健康受试者双膝关节进行MR扫描获取二维图像,把MR二维图像导入Mimics软件中对股骨髁间窝进行三维重建获得三维数字化模型,测量三维数字化模型的髁间窝宽度(ICW)、两髁宽度(ECW)、髁间窝高度(ICH)、髁间窝顶的宽度(BLL)、股骨外髁的宽度(LCW)、股骨内髁的宽度(MCW),计算髁间窝宽度指数(NWI)及髁间窝形态指数(NSI)。2、运用Mimics软件对患者股骨髁间窝三维数字化模型进行虚拟化髁间窝成形术。3、通过术中、术后评估髁间窝成形术后髁间窝和交叉韧带的解剖关系。4、运用SPSS17.0统计学软件进行分析,男女股骨髁间窝数字化模型测量各项数据均数比较采用独立样本t检验,同体左右股骨髁间窝数字化模型测量各项数据均数比较采用配对样本t检验,以α=0.05作为检验标准。[结果]1、男性与女性股骨髁间窝的三维数字化模型的ICW、ECW、ICH、BLL、 LCW、MCW皆具有显著性差异(P<0.05),NWI和NSI无显著性差异(P>0.05)。2、男性及女性左右股骨髁间窝三维数字化模型的ICW、ECW、ICH、BLL、 LCW、MCW、NWI、NSI均无显著性差异(P>0.05)。3、ACL重建术中参照术前虚拟切除骨量进行髁间窝成形,术中观察重建韧带在膝关节过伸位上刚好接近髁间窝顶壁及侧壁,术后3月重建膝关节三维数字化模型发现重建的交叉韧带与髁间窝无撞击。[结论]男性与女性髁间窝解剖形态显著性差异,NWI及NSI无差异；同体左右股骨髁间窝各测量指标无显著性差异；髁间窝指数是反映髁间窝狭窄程度的指标之一,有利于指导髁间窝成形术；虚拟髁间窝成形术具有可行性,它可为前交叉韧带重建术中髁间窝成形提供术前参考,具有一定的临床指导意义。更多还原

【Abstract】 Part1. The anatomy research on3-D digital anatomic model based on MR images of intercondylar notch compared with entity anatomy measured dataObjectiveWith the development of Computer Assisted Technique and digital anatomy, to establish the digital anatomic model of intercondylar notch could find a new path for anatomic study on intercondylar notch. To explore the accuracy and feasibility of3-D digital model of femoral intercondylar notch based on MR images through comparing the differences of anatomic data between3-D digital model and cadaver.Methods1. To scan and get2-D MR images from18male fresh frozen cadaveric knees and14female fresh cadaveric knees. The MR images were imported into Mimics Software for3-D intercondylar notch reconstruction, and the related anatomical data which were gotten from the3-D digital model named as3-D reconstruction group and the data of ICW, ECW, ICH, BLL, LCW, MCW, SLLC, SLMC, ALC, AMC were measured.2. The cadaveric of18male and14female knees were dissected and measured the anatomic data which were named as entity group and the data of ICW, ECW, ICH, BLL, LCW, MCW, SLLC, SLMC, ALC, AMC were measured.3. To analyze the data of the two groups by paired-samples t test of SPSS17.0statistical software, with a=0.05as a standard deviation.Results1. The measured values of ICW, ECW, ICH, BLL, LCW, MCW, SLLC, SLMC, ALC, AMC in male had no differences between the3-D reconstruction group and entity group (P>0.05). 2. The measured values of ICW, ECW, ICH, BLL, LCW, MCW, SLLC, SLMC, ALC, AMC in female had no differences between the3-D reconstruction group and entity group (P>0.05).ConclusionThe3-D digital model based on MR images could accurately show the entity specimens information. It could be used for anatomic research of the normal femoral intercondylar notch. It was important for diagnosis and treatment on the related diseases of intercondylar notch and ACL reconstruction.Part2. The digital anatomic research on3-D digital intercondylar notch model based on MR imagesObjectiveWith the development of Computer Assisted Technique and digital anatomy, the digital anatomic model of intercondylar notch had been used for anatomic study. It had been provided a new path for anatomic study on intercondylar notch. To establish3-D intercondylar notch of the healthy adult knee based on2-D MR Images, and the index of anatomy and its difference between sex, left and right knees. To study the feasibility of virtual intercondylar notchplasty before the ACL reconstruction.Methods1. There were15male and15female bilateral knees of healthy adult scanned by2-D MR images. The MR images were imported into Mimics Software for3-D intercondylar notch reconstruction, and the related anatomic data of the3-D digital model were gotten.2. The intercondylar notchplasty was simulated with3-D intercondylar notch model in Mimics software.3. The anatomic relationship between intercondylar notch and ACL was evaluated during operation and after operation.4. To analyze the data of the two groups of male and female by independent sample t test and two groups of left and right knee by paired-samples t test of SPSS17.0statistical software, with a=0.05as a standard deviation. Results1. The values of ICW, ECW, ICH, BLL, LCW, MCW in3-D digital knee model had significant difference between male and female(p<0.05), But no difference in the NWI between male and female(p>0.05).2. There was no significant difference between the left and right on ICW, ECW, ICH, BLL, LCW, MCW, NWI, NSI in3-D digital knee model of male and female (p>0.05).3. Intercondylar notchplasty was done by preoperative simulated plan with3-D digital model, and it was just fit for the intercondylar notch top and side wall, and the postoperative3-D digital model reconstruction of the ACL and intercondylar notch wall had no impingement.ConclusionThe anatomy of intercondylar notch was significant difference between male and female, but it had no difference in NWI and NSI, and the data of intercondylar notch had no difference in left and right. NWI was one of indexes which showed the narrow level of intercondylar notch. The virtual intercondylar notchplasty was feasible, and it could provide preoperative plan for intercondylar notchplasty in ACL reconstruction, and it showed important clinical instructing significance.更多还原