摘要
目的探讨成人CroweⅢ、Ⅳ型髋关节发育不良(DDH)患者股骨近端应力负荷对股骨髓腔形态的影响。方法病例对照研究。纳入2019年1月—2021年6月解放军总医院第一医学中心和第四医学中心行初次全髋关节置换术的成人DDH患者47例,其中CroweⅢ型21例,CroweⅣ型26例。同期选取单侧股骨头坏死患者26例健侧股骨26侧作为对照组。将DDH患者根据有无假臼分为2组:假臼组23例,纳入股骨25侧;无假臼组24例,纳入股骨34侧。使用Mimics 19.0软件对股骨CT图像进行股骨髓腔拟合。切片重组后使股骨解剖轴垂直水平面,从小转子近端20 mm到远端80 mm间隔10 mm或20 mm选取1个平面并分别标记为T+20、T+10、T0、T-10、T-20、T-40、T-60、T-80共8个平面,统计并比较3组患者在股骨长轴8个平面上股骨髓腔拟合椭圆的长径、短径、髓腔圆度指数、髓腔扭转角及其变化率(VFMTA)。结果对照组、假臼组、无假臼组被检者的性别、年龄、身高、体质量及体质量指数等一般资料比较,差异均无统计学意义(P值均>0.05)。3组的T+20~T-808个平面的股骨髓腔长、短径长度均逐渐减小,髓腔扭转角逐渐增大,组内比较差异均有统计学意义(P值均<0.001)。3组间8个平面的股骨髓腔长、短径长度比较,差异均有统计学意义(P值均<0.05);组间两两比较,假臼组8个平面股骨髓腔的长、短径长度均小于对照组,差异均无统计学意义(P值均>0.05);无假臼组8个平面股骨髓腔的长、短径长度均明显小于假臼组和对照组,差异均有统计学意义(P值均<0.05)。对照组、假臼组、无假臼组8个平面股骨髓腔扭转角依次增大,组间两两比较,差异均有统计学意义(P值均<0.05)。对照组、假臼组、无假臼组8个平面的髓腔圆度指数均表现出先减小后增大的趋势,差异均有统计学意义(P值均<0.001)。3组在T0、T-10、T-40平面的圆度指数组间比较,差异均有统计学意义(P值均<0.0
ObjectiveThis study aimed to investigate the effect of proximal stress loading on the morphology of the femoral medullary cavity in adult patients with Crowe typesⅢandⅣdevelopmental dysplasia of the hip(DDH).MethodsA case-control study was performed on 47 adult patients with DDH who underwent primary total hip arthroplasty from January 2019 to June 2021 at the First Medical Center and Fourth Medical Center of PLA General Hospital.Among them,21 had Crowe typeⅢand 26 had Crowe typeⅣ.When both hips met the requirements,both were included.In addition,a control group composed of 26 femurs from patients with unilateral femoral head necrosis on the healthy side was established during the same period.The patients were divided into false and non-false acetabulum groups according to the presence or absence of a false acetabulum,respectively.The false acetabulum group had 23 cases,including 25 femurs,whereas the non-false acetabulum group had 24 cases,including 34 femurs.Mimics 19.0 software was used to fit the femoral medullary cavity according to the CT images.After section recombination,the femoral anatomical axis was made perpendicular to the horizontal plane.A plane was selected from the proximal end of the small rotor 20 mm to the distal end 80 mm and labeled as T+20,T+10,T0,T-10,T-20,T-40,T-60,and T-80,respectively.Eight planes were selected in total.The length of the long axis,length of the short axis,roundness index of the femoral bone marrow cavity,twisting angle of the marrow cavity,and change rate(VFMTA)of the femoral bone marrow cavity fitting ellipse on eight femur axis cross-sections were analyzed and compared in the three groups.ResultsNo significant differences in gender,age,height,mass,and body mass index were found among the control,false acetabulum,and non-false acetabulum groups(all P values>0.05).The transverse length and short diameters of eight femoral bone marrow cavities in the T+20-T-80 groups in the control,false acetabulum,and non-false acetabulum groups gradually decreased,and the twist
作者
李明峰
宋朝晖
肖龙涛
郭人文
孔祥朋
柴伟
Li Mingfeng;Song Zhaohui;Xiao Longtao;Guo Renwen;Kong Xiangpeng;Chai Wei(School of Medicine,Nankai University,Tianjin 300071,China;Institute of Orthopaedics,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Orthopaedics,Sports Medicine and Rehabilitation,Beijing 100853,China;Department of Orthopaedics,Wenshang County People's Hospital,Jining 272599,China;Institute of Orthopedics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华解剖与临床杂志》
2024年第7期456-463,共8页
Chinese Journal of Anatomy and Clinics
基金
国家自然科学基金(U22A20355)。
关键词
髋关节
髋关节发育不良
髋臼
股骨髓腔形态
应力
Hip joint
Developmental dysplasia of the hip
Acetabulum
Femoral medullary cavity morphology
Stress
