摘要
目的研究在CT图像上以水平面和真骨盆平面作为参照进行的关节置换髋臼相关参数所产生的差异,明确其对手术效果的可能影响。方法收集南京大学医学院附属鼓楼医院正常髋关节CT影像80例。研究对象的入选标准包括：CT检查范围包含骨盆、髋臼及全部股骨头;髋臼、股骨头和骶髂关节等无明显病变;被检查者在扫描时无强迫体位。排除标准包括：强直性脊柱炎,合并其他脊柱疾病及髋、膝关节固定畸形者;因急腹症或其他急诊疾病导致CT检查时可能导致强迫体位者;有外伤或骨折病史者。其中男44例,女36例,平均年龄（40±6）岁（18-55岁）。CT在自然平卧位下以垂直水平面扫描,在CT定位片及扫描图像上测量双侧髋臼的前倾角、外展角、股骨头中点-髋臼边缘（CE）角、髋臼宽度、髋臼深度、髋臼角,并测量真骨盆平面与水平面间的夹角。采用CT软件将影像作三维重建,并重新垂直于真骨盆平面进行扫描,用同样方法测量上述参数。采用配对t检验比较左右侧髋臼及两个平面下参数的差异,成组t检验比较男女髋臼的差异,两个参考平面的夹角与所测量参数的差值相关性采用Spearman相关性分析,P〉0.05）、（真骨盆平面上：t=1.58、0.47、1.19、-1.25、0.27、0.36,P＆gt;0.05）,但存在明显的性别差异。在水平参照面组中外展角、髋臼宽度、髋臼深度女性显著小于男性（t=-4.01、-6.69、-7.19,P〈0.01）;真骨盆参照面组中前倾角、CE角、髋臼宽度、髋臼深度女性显著小于男性（t=-2.61、-1.47、-2.92、-10.02、-4.44,P〈0.05）,髋臼角女性显著大于男性（t=3.49,P〈0.01）。骨盆倾斜角度与两参照面间髋臼前倾角、CE角差值呈正相关（r=0.49、0.29;P〈0.05）,与髋臼深度、髋臼角差值呈负相关（r=-0.29、-0.22;P〈0.05）。结论平卧位CT扫描时骨盆存在旋转,直接测量的髋臼参数与以真骨盆平面作为参考的参数存在误差,在做术前计划时应当引起足够重视。
Objective To investigate the differences of acetabulum related parameters between the horizontal plane and true pelvis plane on CT images,and explore the impact on the operation. Methods The hip CT images of 80 normal cases in Affiliated Drum Tower Hospital,Nanjing University,were collected with natural supine position. Inclusion criteria： CT images contain all the pelvises,acetabula and femoral heads; no obvious pathological change in the acetabula,femoral heads and sacroiliac joints; the inspected patients with no forced postures when scanning. Exclusion criteria： ankylosing spondylitis or other spine,hip and knee fixed deformity diseases; forced postures because of the emergency diseases; a history of trauma or fracture. There were 44 males,36 females,average age was（ 40 ± 6） years（ 18- 55 years）. The direction of CT scanning was perpendicular to the horizontal plane. Bilateral acetabular anteversion angle,abduction angle,center-edge angle（ CE angle）,acetabular width,acetabular depth and acetabular angle were measured,as well as the angle between the true pelvis plane and horizontal plane. All the CT images were performed three-dimensional reconstruction,then the images were collected with the scanning direction perpendicular to the true pelvis plane. The same parameters were measured. Paired t test was used to compare the differences of the outcomes between the left and right sides of the acetabulum,as well as the ones between the two reference planes. Group t test was adopted to compare the differences of parameters between male and female. Spearman correlation analysis was performed to indicate the association of the parameters differentials and the reference planes angle. P 〈 0. 05 was considered as significant difference.Results There was no significant difference between the parameters of the two sides of the acetabulum in both reference planes（ in horizontal plane： t =- 0. 06,- 0. 75,- 0. 33,- 1. 24,0. 62,0. 14,P 〉 0. 05）,（ in true pelvis plane t = 1. 58,0. 47,1. 19,- 1. 25,0. 27,0. 36,P 〉0. 05）. Statistical significance was detected between the genders. In horizontal plane,the abduction angle,acetabular width and depth were remarkably higher in male（ t =- 4. 01,- 6. 69,- 7. 19,P 〈0. 01）,and acetabular angle was higher in female（ t = 3. 49,P 〈 0. 01）. The pelvic tilt was positively correlated with the difference of acetabular anteversion angle and CE angle（ r = 0. 49、0. 29; P 〈 0. 05）,and was negatively correlated with the difference of acetabulum depth and angulus acetabularis（ r =- 0. 29,- 0. 22; P〈 0. 05）. Conclusion Traditional CT measurement of acetabulum parameters may result in errors,so more attentions should be paid during the pre-operative planning by the surgeons.
出处
《中华关节外科杂志（电子版）》
CAS
2016年第1期20-25,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
江苏省"六大人才高峰"第十批高层次人才项目(WSW-002)
南京市医学发展项目杰出青年基金(JQX13008)
南京市医学发展项目一般性课题(YKK12081)
关键词
体层摄影术
X线计算机
髋关节
髋臼
成像
三维
Tomography
X-ray computed
Hip joint
Acetabulum
Imaging
three-dimensional
