【作者】 储建军；

【导师】 尹宗生； 胡勇；

【作者基本信息】 安徽医科大学 ， 骨外科学， 2008， 硕士

【摘要】 目的:利用髋关节的三维CT影像,通过数字化处理,作可视化动画重建,探讨发育性髋关节脱位(developmental dislocation of the hip,DDH)股骨颈前倾角(femoralneck anteversion,FNA)的病理改变,为术式的选择提供依据。方法:2005年1月～2007年5月间在我院行手术治疗的30例DDH患儿术前进行3DCT研究.患有神经肌肉性疾病、合并有其它先天畸形者被排除在外。男11例,女19例,年龄1.5～13岁(平均7.29岁),其中CroweⅡ6例,CrowemⅢ型10例,CroweⅣ型14例。术前用GE Lightspeed VCT(64排CT,美国GE公司生产)扫描双侧髋关节和双侧股骨髁部,扫描后的图像重建在独立工作站进行,分别对髋臼和股骨头颈部的形态做前方、后方、侧方和仰视位观察,行双侧髋关节薄层平扫+三维重建,测量股骨颈前倾角(FNA),分别计算其FNA,并指导术中股骨旋转截骨,前倾角＞45°作旋转截骨(FNA分别旋转1～6岁为:20.00±2.00,＞6岁为18.00±2.00),术后双侧髋关节再行薄层平扫+三维重建,正常侧髋分别与患侧术前及术后作为比较并作统计学处理,30例30髋获得3个月～2年随访(平均13个月)。结果:分别对术前、后双侧髋关节股骨颈前倾角行三维空间成像,DDH骨性病理包括髋臼、股骨头颈和两者的对应关系的变化,其中髋臼的病理可以表现为髋臼方向的变化或者是髋臼的骨性缺损(主要表现在外上缘部位),股骨头颈的前倾角变化是DDH的主要病理因素之一。三维CT的观察结果表明18个月～6岁组:正常侧FNA:(21.40°±3.512°);脱位侧术前FNA:(68.45°±12.272°),术后FNA:(20.45°±2.940°);=6岁组正常侧FNA为:(23.44°±3.561°);脱位侧术前FNA:(73.49°±12.678°),术后FNA:(18.28°±1.931°),术后早期均获得满意FNA和头臼对位。统计学分析结果显示,患侧FNA术前较正常侧明显增大(P＜0.05),术前两侧有统计学有明显差异性,术后相统计学上均无显著意义。结论:螺旋CT的三维重建方法简单、精确、可重复性强。3DCT可以直观地显示股骨近端的结构形态改变,通过多平面重建技术(MPR),可以精确地测量股骨颈前倾角的大小,是测量股骨颈前倾角理想的方法,对DDH的治疗具有很好的指导意义。更多还原

【Abstract】 Objective:Femoral neck anteversion was one of the main and basical pathological changes,normalizing their hip anantomy might prevent or delay the development of osteoarthrosis.This is the concept of reconstrutive osteotomy,in which the primary aim of the surgical treatment is to improve the longterm prognosisof the hip join to discus the femoral neck anteversion of DDH and to guide operating with visual and digitalizing picture in 3DCT and to provide a reasonablo basis of the examination for clinic analyzing 3DCT findings of the DDH.Method:During the past three years(1999.6 -2002.6),thirty children with unilateral DDH had been diagnosed and treated with open reduction,nineteen female patients and eleven male patients,age was ranging from 18 months to 13 years old with an average age of 7.29 years old,six of them were gradeⅡ°and 10 were gradeⅢ°and 14 were gradeⅣ°according to Crowe clasification,were analysed using 3DCT,GE Lightspeed VCT Picker)was used for this study.The femoral condyles were scanned and the 3DCT images were constructed at an independent computer workstation,children that FNA exceed 45°received the subtrochanter osteotomy,images from different direction,FNA of hip were measured respectively before and after operation respectively and were measured in normal and abnormal hips respectively,FNA of hip respectively statistical treatment.30 patients(30 hips) were followed up ranging from 3 months to 2 years with mean 13 months.Result:The bone pathology of DDH included the femoral head and abnormalities of acetabulum,and the congruous relationship between acetabulum and femoral head.FNA abnormality was one of the main elements in the DDH pathology。In group younger than 18 months,the FNA were in normal hips(21.40°±3.512°),in dysplasia hips respectively,the FNA were(68.45°±12.272°),the FNA were measured (20.45°±2.940°) after operation:in group elder than 6 yers,there were significantly statistical differences,the FNA were in normal hips(23.44°±3.561°),in dysplasia hips respectively,the FNA were(73.49°±12.678°),the FNA were measured(18.28°±1.931°) after operation.Clinical assessment was performed according to Mckay’S classification.The satisfactory congruity FNA was achieved in all the cases at the early stage postoperatively.The results showed that.FNA was increased significantly (p＜0.05)as compared with normal group and the overall excellent or good rate was 96.6%.Conclusion:3D-CT method is a new accurate and convenient and reduplicative method for measuring FNA and 3DCT reonstruction techniques can intuitionistic reveal.The change of structure and shape of femoral head and acetabulum.we can get accurate datum of FNA with MPR.It will be more helpful for related operations when three-dimendional images are considered.更多还原