新疆维吾尔族汉族女性数字化三维骨盆及生理常数的对比研究
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摘要
骨盆是人体骨骼系统中重要的组成,在女性,骨盆更是与妊娠、分娩及某些妇科疾病密切相关。由于研究方法的局限,人们对其一直无法深入了解。1895年X线被发现,随后其被国内外许多学者广泛运用于骨盆测量,而国内起步较晚,上世纪50年代,我国学者开始致力于女性骨盆的研究,30余年间,他们利用X线测量技术完成大规模中国女性骨盆的测量和研究工作,为产科临床做出重大的贡献。其研究阶段大致为：1983年至1985年王淑雯、岳琏等人组织大规模女性骨盆测量工作,1986年至1989年各协作组数据收集整理阶段,最终给出目前我国临床上广泛应用的骨盆测量数据。其中,在维吾尔族女性骨盆生理参数研究中他们发现：该民族女性骨盆各平面主要径线与全国总体数据及汉族数据均有显著差异,跟欧美女性接近,具有国际性。但当时由于地域、技术、经费等种种原因的限制,仅仅选取了天山内麓及玛纳斯县的少部分维吾尔族女性骨盆X线测量数据。而随后至今的近30年间,国内妇产科界再也没有对女性骨盆进行新一轮的研究。在这段时间里,中国社会在文化、经济、生活习惯等方面都发生了巨大变化,而国外学者的研究表明,女性骨盆的形态及径线较从前发生明显的改变,总体趋势是越来越不利于自然分娩,但是目前,我国骨盆的临床应用数据源自二十余年前的“信息”,各个民族采用统一的径线,没有种族、地域之分。
我国是以汉族为主、多民族组成的国家,其中部分少数民族与汉族并非同一人种,由于遗传的原因,她们的骨骼是有明显的差异。研究表明：骨盆形态及特征会因营养、生活劳作习惯以及地域不同而不同,有着显著的地域性及种族特点。新疆是一个多民族聚居的地区,各民族人种并不相同,其中人数最多的两个民族中汉族则源自蒙古人种,维吾尔族属于高加索及蒙古人种的混血种族。国外研究表明：骨盆径线在不同人种间存在着显著的差异,这也与我国30年前进行的女性骨盆大样本测量研究结果相符。1987年,新疆学者李秀凤等采用手工和X线测量,对100例新疆维吾尔族女性和100例汉族女性的骨盆生理常数进行测量分析,显示两个民族间存在明显差异。此后20多年,国内外基本上没有对新疆地区女性骨盆形态和生理常数进一步研究,并且上述数据源自20多年前的研究,方法局限,代表性并不强。
医学的前进从来是伴随着科学技术的进步,随着影像学技术的发展,国外学者采用电子计算机X射线断层扫描技术(Computed Tomography,CT)及磁共振成像(Magnetic Resonance Imaging,MR)设备进行女性骨盆研究,其不但可以进行产科径线测量,亦可以应用于产前诊断及某些妇科疾病的诊断治疗,但国内在这些方面的研究显著落后于国外。随着我国经济发展、居民生活水平的提高,新疆地区女性骨盆很可能也发生了一定的变化,这些变化是否影响该地区女性骨盆的发育?影响的程度如何?有何临床意义?出于维护民族团结、地区稳定以及减少医疗纠纷的需要,对新疆地区女性骨盆进行深入研究显得十分必要。
工欲善其事必先利其器,寻找一个好的方法进行女性骨盆研究显得尤为重要,关于女性骨盆的最经典的研究方法不可否认是X线测量,但是X线骨盆测量方法受限于拍摄角度和体位的影响,亦存在中骨盆摄片的盲区、二维图片信息量少以及放射线剂量大等问题,临床应用受到一定限制。近年来,随着计算机技术的发展,女性骨盆研究方法也发生了很大变化。在医学领域中,实时数字图像处理技术有着极其广泛的应用前景,其核心技术是三维重建,它是指应用逆向工程软件,将连续二维图像转换成数字化三维模型的理论与方法,采用实时数字图像处理技术研究人体解剖结构是目前最先进的方法之一,国外学者较早开启了这方面的研究。
1982年美国学者Federle MP等首次进行二维CT女性骨盆测量,2003年,法国学者Balleyguier C等首次运用CT扫描数据完成骨盆三维数字化模型重建,并进行部分径线测量,文章认为利用CT重建出来的骨盆三维数字化模型不仅能进行任意角度的观察及测量,而且更容易被临床医生和助产士所理解。目前,国内采用数字化技术对女性骨盆的研究刚刚起步,且主要集中于南方汉族女性,尚未见将该技术应用于维吾尔族、汉族女性骨盆对比研究的报道。新疆地区维吾尔族女性有多次分娩史者较多,具有两次或者两次以上剖宫产手术者较其他地区多见,切口愈合不良时有发生,严格控制剖宫产指征在该地区显得尤为重要,查阅文献我们发现导致上述情况发生的原因除了社会经济、患者观念等非医源性因素外,还包括临床医生对相对头盆不称诊断标准掌握欠准确,导致剖宫产指征扩大化等医源性因素。原有骨盆测量方法有很大的局限性,目前临床上采用骨盆外测量方法只能间接评估骨产道的情况,却不能完成同自然分娩关系密切的骨盆内测量及形态分析。虽然自然分娩过程和产力、软产道、胎头大小都有关,但骨盆是一个更加重要因素,同时骨盆相对固定,借助数字化三维重建技术可以在产前进行更准确详细的评估。
本课题采用数字化三维重建技术构建新疆地区维吾尔族、汉族女性骨盆数字化模型,结合Geomagic软件、UG软件对重建的三维骨盆模型进行随意缩放、切割和任意角度旋转观察,并且直接对骨盆进行相关解剖形态学、产科径线及角度的精确测量,得到具有新疆地区女性特点的、不同民族的骨盆生理常数,指导该地区的妇产科临床。但是由于该研究刚起步,研究样本量较少,研究对象目前仅限于生育活跃期女性,有待在后续研究中进一步扩大样本量及研究对象范围。
第一部分基于CT原始数据的正常在体女性数字化骨盆三维重建及测量
[目的]
数字化三维重建运用于临床需要熟练掌握相关计算机软件的操作,图像数据集采集及存储,有别于临床上一般CT或MRI常规检查数据的存储。基于CT扫描的计算机骨盆三维重建是直接采用的活体数据,能最真实地反映人体的解剖情况。应用女性骨盆CT扫描数据结合医学交互软件Mimics成功构建正常在体女性骨盆数字化三维模型,结合Geomagic软件、UG软件,对重建的三维骨盆模型进行随意缩放、切割和任意角度的旋转,不仅可以直接对骨盆进行相关解剖形态学分类、产科径线及角度的精确测量,而且减少了传统测量中人为因素的影响,更真实地反映了骨盆的生理情况。为妇产科相关疾病的研究、诊断以及治疗提供数字化模型和模拟平台。
第一节：材料与方法
一、数据采集及三维重建
1、数据来源
选取一例盆腔CT扫描数据。患者基本资料：女,31岁,新疆和田市人,身高161cm,体重65kg,孕3产3(均顺产),无骨盆、脊柱及下肢外伤史,无盆腔手术史,临床诊断为子宫肌瘤。
2、设备与软件
德国西门子公司生产的64排双源CT (SOMATOM Definition), Mimics10.01重建软件(Materialise公司,比利时),Geomagic软件、UG软件。
3、CT扫描数据采集
扫描时,嘱患者仰卧位,身体位于床面中央,且正中矢状面与床面垂直,双手抱头,双腿伸直并拢。CT平扫条件为：管电压120kV,管电流220mA,层厚5mm,层间距5mm,扫描范围从第三腰椎上缘至股骨中上段,将坐骨结节全部包含在内,扫描后将图像拆薄至层厚为1.0mm,共406层,并刻碟保存。
4、骨盆三维重建
将拆薄后的平扫期骨盆原始数据导入Mimics10.01软件(Materialise公司,比利时)中,经定位图像、组织图片、内插值处理后,设定骨组织重建阈值为226HU,以显示骨盆结构尽量丰富但不至骨盆“毛糙”为准,阈值上限采用系统默认值；应用Mimics软件中蒙罩编辑(Edit masks)中的涂画(Draw)工具,视缺损程度对坐骨棘、骶骨等处按照CT断层图像进行修饰；经区域增长、3D计算重建出包含部分腰椎及股骨的女性骨盆数字化三维模型；采用光滑按钮,对重建出的骨盆进行光滑处理,增强骨盆模型的真实感和立体感。最后将重建的三维骨盆模型分别以STL和JPG的格式导出。
5、骨盆分割
在Geomagic软件中新建文件,导入全骨盆STL文件,旋转骨盆使其左右对称,用平面裁剪功能,选取“直线”,经骶岬中点与耻骨联合做一直线,进行平面截面,选取并删除右半骨盆,保留左半骨盆,封闭相交面,将左半骨盆以STL格式导出文件。
6、骨盆测量
将全骨盆及左半骨盆的数字化模型分别导入UG软件中,利用全骨盆的数字化三维模型测量骨盆入口横径,入口后矢状径,中骨盆横径,中段后矢状径,出口横径,出口后矢状径,耻骨弓角度；利用右半骨盆的数字化三维模型对骨盆入口前后径,骶耻内径,中骨盆前后径,出口前后径,耻骨联合高度,骶骨长度,骶骨弯度进行测量,以mm为单位(精确到百分位)。由2名经过培训的人员独立进行测量,每个骨盆共测量了12条经线及2个角度(图1-2)。其测量标准参照王淑雯等研究的标准测量据点。
第二节：结果
采用CT扫描的女性骨盆原始数据,利用数字化三维重建技术,结合医学交互软件Mimics可以重建出完整的全骨盆,而且利用Geomagic软件可以选择性的重建出部分骨盆结构,如左、右半侧骨盆。重建的女性骨盆腰椎椎体及锥弓的形态和关系分明,髋骨形态规则、清晰；骶骨表面光滑,弧度自然,双侧骶孔清晰可见,尾骨形态完整,骶髂关节、骶尾关节和耻骨联合清晰可辨。模型可以进行随意缩放、切割和任意角度的旋转,并可以以图片和动画的形式导出,格式通用,便于对其进行进一步的后处理。Mimics和UG软件可以对模型进行三维测量,自动生成显示测量径线和角度的结果。结果可以精确到0.001mm和0.001度。在三维空间内,利用全骨盆的数字化三维模型可以测量骨盆入口横径,入口后矢状径,中骨盆横径,中段后矢状径,出口横径,出口后矢状径,耻骨弓角度；利用右半骨盆的数字化三维模型可以对骨盆入口前后径,骶耻内径,中骨盆前后径,出口前后径,耻骨联合高度,骶骨长度,骶骨弯度进行测量,该测量方法可以多次重复使用,有利于骨盆测量的推广运用。
第三节：结论
1.基于CT扫描的计算机骨盆三维重建是直接采用活体数据,重建的三维骨盆模型不仅可以进行随意缩放、切割和任意角度的旋转,而且可以直接对骨盆进行相关径线和角度的精确测量,减少了传统测量中人为因素的影响,没有X线测量和外测量在中骨盆平面中三维盲区,更真实地反映了骨盆的生理情况。
2.利用Mimics软件,可以获取在体女性骨盆的数字化三维模型,将Geomagic软件及UG软件引入研究中,直接读取DICOM格式的原始图像,完善了Mimics软件的测量功能。
3利用Mimics软件中三维径线测量和三维角度测量工具可以在重建好的骨盆模型中对临床常用的相关径线和角度进行测量。
4该方法使三维重建和测量的所有操作在普通电脑上直接进行,容易普及并完成大批量数据的采集工作。方便在临床应用于建立个体化虚拟骨盆,为妇产科相关研究提供技术平台。
第二部分新疆地区维吾尔族女性数字化骨盆三维重建及生理常数的测定
[目的]
国外研究表明：骨盆形态及特征会因营养、生活劳作习惯以及地域不同而不同,有着显著的地域性及种族特点。为了解新疆地区正常维吾尔族女性骨盆形态的变化,我们在前期构建成功的在体正常女性骨盆数字化三位重建研究的基础上进一步利用CT三维重建和改良的骨盆测量技术对在体新疆正常维吾尔族女性的骨盆进行数字化三维重建,并对重建成功的骨盆进行主要经线的测量,尤其是骨盆的主要产科径线及角度,得出现代新疆维吾尔族育龄女性骨盆的生理常数值,明确其骨盆精细解剖特点及产科生理常数。测量过程中,我们发现维吾尔族女性骶尾关节异常比率较高,专门提取了骶骨部分进行了详细的形态学及生理常数的测量。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的维吾尔族生育活跃期女性100名,年龄25-40岁,平均年龄(31.6±6.7)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有至少一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。
2、软件与设备、三维重建和测量方法：同第一部分。另Mimics10.01软件蒙罩编辑(EditM asks)工具将骶骨同髂骨分离,三维重建构建出单独的骶骨数字化三维模型。将其导入UG软件中,对骶骨长度、骶骨弯度、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度进行测量。
3、统计方法：将获得的骨盆测量数据,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差。
第二节：结果
1、采用CT扫描的维吾尔族女性骨盆原始数据,利用数字化三维重建技术,结合医学交互软件Mimics成功重建出完整的全骨盆；利用Geomagic软件可以选择性的重建出部分骨盆结构,如左、右半侧骨盆。重建出的维吾尔族女性骨盆模型各骨性标志清晰可辨,可以进行随意缩放、切割和任意角度的旋转,用Mimics和UG软件对该数字化三维骨盆模型进行产科生理常数的精确测量。
2、新疆维吾尔族女性骨盆产科生理常数各径线测量：每个骨盆共测量12条经线：骨盆入口横径(136.70±7.23mm),入口后矢状径(47.67±7.59mm),中骨盆横径(105.36±6.17mm),中段后矢状径(42.06±6.40mm),出口横径(114.09±10.35mm),出口后矢状径(66.13±9.09mm),骨盆入口前后径(113.52±7.88mm),骶耻内径(124.10±9.87mm),中骨盆前后径(121.22±7.11mm),出口前后径(111.27±8.72mm),耻骨联合高度(32.22±3.45mm),骶骨长度(105.87±9.53mm)共12条经线及耻骨弓角度(90.49±8.44°),骶骨弯度(131.73±10.31°)2个角度。
3、新疆维吾尔族女性骶骨形态特点及生理常数的测定：100例维吾尔族女性中有63例(63%)为标准型；有7例为非标准4对骶孔型,其中包括腰椎完全骶化2例,腰椎不全骶化3例,骶椎腰化2例；5对骶孔型有10例(10%)；骶尾关节异常型(包括尾骨上翘型或尾骨骶化型)有20例(20%)。按照骶骨分型分别测量了以下骶骨生理常数：骶骨长度(4对骶孔标准型：106.6±12.0mm；4对骶孔非标准型：96.4±11.2mm；5对骶孔型：126.6±12.7mm骶尾关节异常型：116.0±10.2mm)、骶骨弯度(4对骶孔标准型：132.8±13.20；4对骶孔非标准型135.1±3.90；5对骶孔型：134.7±3.7°；骶尾关节异常型：160.8±4.20)、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度(分别测量第一、二、三、四骶孔,见正文)。
4、现代新疆维吾尔族女性骨盆类型特点：在100例新疆维吾尔族女性中,女型42例,占42.0%；扁平型38例,占38.0%；类人猿型15例,占15.0%；男型5例,占5.0%。以女型和扁平型最常见。
第三节：结论
1.基于CT原始数据,结合医学交互软件Mimics,应用数字化三维重建技术成功重建出100例完整的新疆地区现代维吾尔族女性的骨盆,重建的骨盆平整、光滑,弧度自然,可任意角度旋转观察。利用Geomagic软件可以任意分离切割重建部分骨盆结构,如左、右半侧骨盆及骶骨。Mimics和UG软件对骨盆进行三维测量,共测量14个生理常数。
2.测量中发现新疆地区维吾尔族女性尾骨上翘比率较高,骶尾关节变异者较多,具有自己的特点。
3.在骨盆形态研究中发现：维吾尔族女性以女型和扁平型骨盆为主,类人猿型次之,男型比例最低。
第三部分新疆地区汉族女性数字化骨盆三维重建及生理常数的测定
[目的]
新疆是多民族聚集地区,为了解新疆地区正常汉族女性骨盆形态及产科生理常数的特点,我们在前期利用数字化三维重建技术和数字化测量技术成功构建100例在体正常新疆维吾尔族女性骨盆的基础上,采用相同重建参数对100例在体新疆正常汉族女性的骨盆进行数字化三维重建,并对重建成功的骨盆进行产科生理常数的测量,得到现代新疆汉族育龄女性骨盆的产科生理常数值,明确骨盆精细解剖特点及产科生理常数。为了下一步维吾尔族和汉族女性骨盆形态学及生理常数的详细比较,我们也提取了新疆汉族女性骨盆骶骨部分进行形态学及生理常数的测量。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的汉族生育活跃期女性100名,年龄25-40岁,平均年龄(30.1±5.8)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。
2、软件与设备、三维重建和测量方法：同第一部分。另Mimics10.01软件蒙罩编辑(EditM asks)工具将骶骨同髂骨分离,三维重建构建出单独的骶骨数字化三维模型。将其导入UG软件中,对骶骨长度、骶骨弯度、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度进行测量。
3、统计方法：将获得的骨盆测量数据,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差。
第二节：结果
1、将CT扫描的汉族女性骨盆原始数据,结合数字化三维重建技术,利用医学交互软件Mimics成功重建出100例完整的全骨盆；利用Geomagic软件能够任意重建部分骨盆结构,如左、右半侧骨盆、骶骨等。重建参数完全与维吾尔族女性骨盆重建参数相同。重建出的汉族女性骨盆模型立体、清晰,各骨性标志清楚,可以进行随意缩放、切割和任意角度的旋转,随后用Mimics和UG软件对汉族女性数字化三维骨盆模型进行产科生理常数的精确测量。
2、新疆汉族女性骨盆产科生理常数各径线测量：与维吾尔族女性相同,每个骨盆共测量12条经线：骨盆入口横径(131.58±6.61mm),入口后矢状径(52.90±7.82mm),中骨盆横径(104.78±6.93mm),中段后矢状径(43.89±5.34mm),出口横径(114.23±8.39mm),出口后矢状径(67.13±8.51mm),骨盆入口前后径(118.44±6.64mm),骶耻内径(130.33±8.39mm),中骨盆前后径(121.26±7.01mm),出口前后径(110.87±8.59mm),耻骨联合高度(32.45±2.95mm),骶骨长度(108.33±9.50mm)共12条经线及耻骨弓角度(88.52±8.46°),骶骨弯度(135.21±11.34°)2个角度。
3、新疆汉族女性骶骨形态特点及生理常数的测定：100例汉族女性骶骨94例均为符合解剖学描述的标准型,未见尾骨上翘情况。按照骶骨分型分别测量了以下骶骨生理常数：骶骨长度(4对骶孔标准型：102.9±11.8mm；5对骶孔型：125.8±13.2mm)、骶骨弯度(4对骶孔标准型：134.8±14.6°；5对骶孔型：135.2±3.2°)、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度(分别测量第一、二、三、四骶孔,见正文)。
4、新疆汉族女性骨盆类型特点：在100例新疆汉族女性中,女型骨盆为主,65例,占65.0%;其次是类人猿型,18例,占18.0%；扁平型骨盆较少见,13例,占13.0%；男型骨盆最少见,4例,占4.0%。。以女型和类人猿型骨盆最常见。
第三节：结论
1.在前期应用数字化三维重建及测量技术完成100例新疆维吾尔族女性骨盆重建和测量的基础上,我们将100例新疆地区汉族女性CT原始数据,结合医学交互软件Mimics,采用同维吾尔族女性骨盆重建的相同参数,也成功重建出100例完整的新疆地区维吾尔汉族女性的骨盆,重建的骨盆三维立体感强,各解剖标志清晰,可任意角度旋转、缩放、分割及测量。
2.利用Geomagic软件可以任意分离切割重建部分骨盆结构,如左、右半侧骨盆及骶骨。Mimics和UG软件对骨盆进行三维测量,共完成了产科14个生理常数测量。
3.为与维吾尔族女性骨盆形态学及产科生理常数进行详细比较,也单独分离重建了汉族女性的骶骨,明确其形态特点,并完成骶骨生理常数的测定。重建的100例汉族女性骶骨未见尾骨上翘情况。
4.在骨盆形态研究中发现：新疆现代汉族女性骨盆形态以女型和类人猿型骨盆为主,扁平型次之,男型比例最低。
第四部分新疆地区维吾尔族汉族女性骨盆生理常数对比研究
[目的]
女性骨盆是影响分娩的主要因素之一,女性骨盆的形成及发育受气候、营养、饮食及劳作习惯等多方面因素的影响,随着经济、文化和生活水平的提高,女性骨盆也在发生变化。但我国目前产科临床上沿用的仍是20多年前的骨盆数据,并且没有民族之分。本研究对利用数字化三维重建技术及数字化测量技术重建成功的维吾尔族、汉族女性骨盆产科生理常数各径线测量数值进行对比,以期在制定产科径线标准上,突出不同民族间的差异性,为制定适合该地区女性骨盆参数提供参考。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的汉族及维吾尔族生育活跃期女性各100名,分别为新疆维吾尔族组、新疆汉族组,年龄25-40岁,维族平均年龄((31.6±6.7))岁,汉族平均年龄(30.1±5.8)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有至少一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。对其骨盆进行主要径线的测量,并对数据进行对比分析。
2、软件与设备：同第二、第三部分。
3、三维重建和测量方法：同第二、第三部分。
4、统计方法：
4.1将获得的两组骨盆测量数据进行比较,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差,两组间骨盆形态的比较采用卡方检验(Fisher's Exact Test),骨盆生理常数的比较采用独立样本T检验,若P≤0.05则认为对比组间差异有统计学意义。
4.2骶骨测量数据两组之间的比较：求出各组数据的均值及标准差,两组间骶骨形态的比较采用卡方检验(Fisher's Exact Test),两组间计量资料的比较采用独立样本T检验,若P≤0.05则认为对比组间差异有统计学意义。
第二节结果
1、新疆维吾尔族女性和汉族女性骨盆产科生理常数各径线值的比较结果两组在骨盆入口平面的各条径线测量值的差异均有统计学意义(均P<0.05),中骨盆平面的中段后矢状径和出口平面的骶骨弯度差异有统计学意义(均P<0.05),其余各条经线差异均无统计学意义(均P>0.05)。新疆维吾尔族女性骨盆入口横径大于汉族女性(P=0.000),而入口前后径、入口后矢状径、骶耻内径均小于汉族女性(均P=0.000)。维吾尔族女性骨盆中段后矢状径小于汉族女性(P=0.029),骶骨弯度小于汉族女性(P=0.024)。
2、新疆维吾尔族和汉族女性骶骨数字化三维模型生理常数的测量结果、形态及比较
2.1新疆维吾尔族女性和汉族女性骶骨形态及比较：100例汉族女性骶骨94例均为符合解剖学描述的标准型,6例为5对骶孔型。100例维吾尔族女性中有63例(63%)为标准型；有7例为非标准4对骶孔型,其中包括腰椎完全骶化2例,腰椎不全骶化3例,骶椎腰化2例；5对骶孔型有10例(10%)；骶尾关节异常型(包括尾骨上翘型或尾骨骶化型)有20例(20%)。经卡方检验,两个民族女性之间骶骨形态类别有显著性差异(χ2=37.246,P=0.000)。100例维吾尔族女性有20人存在尾骨上翘情况,而汉族女性中未见。二者间存在显著差异(χ2=22.22,P=0.000)。
2.2维吾尔族和汉族女性骶骨数字化三维模型生理常数的测量结果及比较：新疆维吾尔族女性与汉族女性前后骶孔横径、纵径及孔髂线距及骶裂孔宽度的差异无统计学意义(P>0.05)；但骶骨前后孔深距及骶裂孔深度方面差异有统计学意义(P<0.05),维吾尔族女性骶骨前后孔深距及骶裂孔深度显著大于汉族女性。新疆维吾尔族女性及汉族女性的标准型骶骨在骶骨长度及骶骨角度方面差异无统计学意义(P>0.05)。非标准型骶骨例数较少,且基本出现在维吾尔族女性中。
3、新疆维吾尔族女性和汉族女性骨盆类型的比例
在100例新疆维吾尔族女性中,女型42例,占42.0%；扁平型38例,占38.0%；类人猿型15例,占15.0%；男型5例,占5.0%。以女型和扁平型最常见。在100例新疆汉族女性中,女型65例,占65.0%；扁平型13例,占13.0%；类人猿型18例,占18.0%；男型4例,占4.0%。以女型最常见。经卡方检验,两组骨盆类型分布有统计学差异(χ2=17.583,P=0.000)。新疆维吾尔族女性扁平型骨盆比例显著高于汉族女性,但女型骨盆比例显著低于汉族女性。
第三节结论
1、新疆地区维吾尔族女性和汉族女性所测量的14个生理常数有6个存在显著差异,其中4个有差异的常数位于入口平面。新疆维吾尔族女性骨盆入口横径大于汉族女性,而入口前后径、入口后矢状径、骶耻内径均小于汉族女性。维吾尔族女性骨盆中段后矢状径小于汉族女性,骶骨弯度小于汉族女性。
2、在三维重建和测量时发现新疆维吾尔族女性和汉族女性骶骨形态类别差异明显。其中,维吾尔族女性尾骨上翘比例较汉族女性常见。维吾尔族女性骶骨前后孔深距及骶裂孔深度明显大于汉族女性。新疆维吾尔族女性非标准型骶骨例数较汉族女性多。骶椎裂、腰椎骶化或骶椎腰化等骶骨变异的情况多存于维吾尔族女性中。
本研究中骶尾关节异常的维吾尔族女性均有阴道分娩史,与经典产科理论中的难产标志相悖。这些结果提示维吾尔族女性骶骨有其自身的特点。
3、两组间骨盆形态分析显示：新疆汉族女性以女型骨盆为主,其次是类人猿型,扁平型骨盆较少见,男型骨盆最少见。维吾尔族女性中女型和扁平型骨盆均较多,类人猿型较少见,男型骨盆最少见。维吾尔族女性扁平型骨盆比例明显高于汉族女性。
上述产科生理常数测量对比结果显示：新疆维吾尔族女性骨盆有其自身的特点,与汉族女性骨盆之间存在一定差异。因此,在制定产科径线标准上,要考虑到不同民族间的差异性。
全文小结
1、应用在体女性骨盆CT扫描数据结合医学交互软件Mimics, Geomagic和UG软件成功构建出正常女性数字化骨盆三维模型,重建的三维骨盆模型不仅可以进行随意放缩和任意角度的旋转,而且可以直接对骨盆进行相关解剖形态学研究及产科径线及角度的精确测量。
2、收集100例在体维吾尔族女性骨盆CT原始数据集,成功地构建出正常维吾尔族女性数字化骨盆三维模型,并进行了精确测量。结果发现维吾尔族女性尾骨上翘比例较高,骶尾关节异常比例较高,具有自己的特点。
3、采用相同重建参数,完成100例汉族女性数字化骨盆三维模型重建和生理常数的精确测量。
4、维吾尔族、汉族女性各100例骨盆测量数据对比发现：新疆地区维吾尔族女性和汉族女性所测量的14个生理常数有6个存在显著差异,其中4个有差异的常数位于入口平面。
5、新疆维吾尔族和汉族骶骨形态及生理常数测量时发现：新疆维、汉两个民族女性差异明显。其中,维吾尔族女性尾骨上翘比例较汉族女性常见。维吾尔族女性骶骨前后孔深距及骶裂孔深度明显大于汉族女性。新疆维吾尔族女性非标准型骶骨例数较汉族女性多。骶椎裂、腰椎骶化或骶椎腰化等骶骨变异的情况多存于维吾尔族女性中。
6、在骨盆形态上,新疆汉族女性以女型骨盆为主,其次是类人猿型,扁平型骨盆较少见,男型骨盆最少见。维吾尔族女性中女型和扁平型骨盆均较多,类人猿型较少见,男型骨盆最少见。维吾尔族女性扁平型骨盆比例明显高于汉族女性。
本研究结果显示：①基于CT原始数据的骨盆数字化三维重建及测量技术减少了传统X线测量、临床外测量中人为因素的影响,更真实地反映了骨盆的生理情况,是研究骨盆的理想模型,为相关研究提供了技术平台。②新疆维吾尔族女性骨盆有其自身的特点,与汉族女性骨盆之间存在一定差异。因此,在制定产科径线标准上,要考虑到不同民族间的差异性。
The pelvis is an important component in the human skeletal system, in women, the pelvis is closely related to pregnancy, childbirth and various gynecological diseases. Pelvis is playing an important role in human body.Due to the limitations of the research methods, it has been unable to depth understanding. Since1895the X-ray was discovered, Scholars at home and abroad have found an increasingly wide utilization in pelvic measurement. Chinese scholars begined to focus on the female pelvis since the50's of last century. In the following30years, They finished a large-scale study in pelvic measurement by X-ray and mde a great contribution to the clinical obstetrics. From1983to1985, Shuwen-Wang and Lian Yue et al organized and coordinated the female pelvic measurement work flow. The following three years, data collected were analysed and statistics were released finally. The research has thrown up some differengts between the Han and Uighur women pelvis, but the research had focused on the300women In the Tianshan Mountain and Manas County. Great changes have taken place in the social culture, economy, life habit, but the research on the pelvic measurement stagnated. Foreign research shows that the female pelvis morphology and diameter have changed enormously over the last20or30years. The overall trend of these changes is not conducive to the natural delivery. Nowadays, The clinical data of female pelvis without the ethnic and regional differences originate from the "information" twenty years ago.
Xinjiang is a multi-ethnic region inhabited by different races. Uighur ethnic group is a Mixed race by the Caucasus and Mongolia while Han belongs to the Mongolia race.According to foreign theory and practice, There were significant differences in pelvic diameters among different species and the result is agreeable with one by chinese scholars. In1987, one hundred Uighur women pelvises and one hundred Han female pelvises were measured and their characteristics were analyzed by Xiufeng-Li. There were significant differences between group Uighur women and group Han female. After20years, there was no further study on the female pelvis in Xinjiang area. The study cannot fully represents Xinjiang female pelvis now for its time too long, meanwhile200women is quite a small sample, so the results should be treated cautiously.
With the development of computer technology and computer graphics, medical imaging technology has a great improvement. CT and MR were used for female pelvic research, including Obstetric diameter measurement, noninvasive prenatal diagnosis and some gynecological diseases diagnosis and treatment. China lags behind other nations in the field of scientific study. As China's economic development and the living standards of residents upgrading, the pelvis maybe probably change, how to evaluate these effects and what is its significance clinically? That is a question. For the purpose of promoting national reunification, ethnic unity,social stability and reducing medical disputes, it's necessary to an in depth study of the female pelvis in Xinjiang area.
A workman must sharpen his tools if he is to do his work well. The classical method is X-ray pelvimetry. Due to the influence of shooting angle and patient position, pelvic midplane blind zone, two-dimensional pictures, large amounts of radiation, there exists defects in X-ray pelvimetry. In recent years, the female pelvic research method already changed with computer development. The real-time image processing technology has extensive application foreground in medicine area. The core technology is3D reconstruction. This method changes two-dimensional images into three-dimensional model with the help of reverse engineering software. In a word, The real-time image processing technology is a state-of-art anatomical research method.
China is a country with Han nationality as the main body, multi-ethnic country, Part of minority and Han nationality is not the same. Due to the nutrition, living and working habits and regional difference, pelvic diameter has regional and ethnic characteristics significantly.By using digital technology, Research on female pelvis which focus on the Southern Chinese Han women has just started. The technique is not applied to the comparative study between Uighur women and Han women yet. Uighur women in xinjiang area have more multiple delivery history. The rate of repeat cesarean section is higher than that of other areas, and therefore the rate of bad healing of incision is higher. Strictly control the indications for cesarean section is particularly important in the region. Besides the objective factors and social economy, also includes the clinicians in relative cephalopelvic disproportion standard master less accurate. The original pelvic methods have great limitations. Current clinical pelvis measurement method only provide an indirect evaluation of bony. Internal pelvimetry and pelvic morphology are closely associated with the natural childbirth, but these cannot be evaluated now. With the help of three-dimensional reconstruction of digital technology, pelvic factor can be more accurate and detailed assessment.
With the help of geomagic software and ug software,this subject adopting digital three-dimensional reconstruction technique made the digital pelvimetry possible. We have received many data of pelvimetry for our research into the female pelvis in Xinjiang area. Taking into account the differences of nationalities, regions is very important in clinical practice. As for the small amount of sample and the age limitations, more accurate and comprehensive data would be left behind to further research.
Part one:Based on digital Three-Dimensional reconstruction and measurement in vivo CT raw data of the normal female pelvic
[Objective]
Three-dimensional digital reconstruction used in clinical is called for mastering the relevant computer software operation, image data acquisition and storage, it is different from the general clinical CT or MRI routine data storage. Computer pelvic3D reconstruction based on CT scanning is used in vivo data directly, can most reflect the anatomy of human body.Application of female pelvic CT scan data combined with the software Mimics to construct medical interaction in female pelvic three-dimensional digital model, combined with Geomagic software, UG software,3D pelvic model for reconstruction of the random scaling, cutting and arbitrary rotation angle, not only can accurately measure directly related morphological anatomy, obstetric diameter and angle of the pelvis, but also of gynecological preoperative evaluation, operation simulation is used to reduce the human factor influence, the traditional measurement, more truly reflect the physiological condition of pelvis.Digital model and simulation platform for female obstetrics and gynecology diseases, diagnosis and treatment.
The first section:materials and methods
1.Sources of cases:Select one pelvic CT scan data. Patients basic information:female,31years old, and xinjiang hotan city people, height161cm, weight65kg, pregnant3delivery3(all natural), there is no history of pelvis and spine and lower extremity trauma, there is no history of pelvic surgery, clinical diagnosis of uterine fibroids.
2. Equipment and software
Dual-source spiral CT with64rows (SOMATOM Definition German Siemens company), Mimics10.01software (Materialise's interactive medical image control system), Geomagic software, UG reconstruction software.
3.CT raw data acquisition
The patient were scanned by dual-source spiral CT with64rows.the patients were told to keep themselves in supine position, the body in the bed center, and the median sagittal plane and perpendicular to the bed surface, both hands to hold the head, legs straight and close together. CT scanning condition:tube voltage120kV, tube current220mA, thickness5mm, interval5mm, range from the third lumbar vertebra to the superior border of the femur, the ischial tuberosity all included, the layer thickness is1.0mm.
4, Three-Dimensional Reconstruction
The scanning data of pelvis were imported into Mimics10.01software (Materialise, Belgium), organized by the positioning, then set the bone tissue reconstruction threshold226HU, to display the pelvic structure to be rich but not to the pelvis "hair brown" shall prevail, upper threshold using the system default application of Mimics software in value; Mask editor (Edit masks) in the paint (Draw) tools, visual impairment to the ischial spine, sacrum, according to the CT tomographic images were modified by3D calculation; regional growth, reconstructed the female pelvis three-dimensional digital model contains part of femur and lumbar spine, smoothed,enhance the sense of reality of pelvic model and three-dimensional sense.Finally,3D pelvic model were exported in STL and JPG format.
S.Split The Three-Dimensional Digital Model
Create a new file in Geomagic software, import the whole pelvic STL file, rotate pelvis make it symmetrical, with plane cutting function, select the "line", the sacral promontory point and pubic symphysis do a straight line, plane section, select and delete the right half pelvis, retain the left pelvis, closed intersecting planes, export the left pelvis at STL format file.
6. Pelvic measurement
The digital model of the whole pelvis and left pelvis were respectively imported into UG software, using whole pelvic digital3D models for measuring transverse diameter of pelvic entrance, entrance after sagittal diameter, transverse diameter of pelvis, the middle sagittal diameter, transverse diameter of export, export back sagittal diameter, angle subpubic arch, the right pelvis for the anteroposterior diameter of the pelvic entrance, sacropubic diameter of pelvic outlet, anteroposterior diameter, anteroposterior diameter, pubic symphysis height, length of the sacrum sacral, camber measurement,(with the unit of mm). each pelvis were measured12lines of longitude and2angles (Fig.1-2).The measurement standard by Shuwen-Wang of standard measurement sites.
The second section:the results
The CT scanning data of the Uighur, Han female pelvic, combined with the Mimics software, can reconstruct pelvic integrity, and using Geomagic software, we can selectively reconstruct part of pelvic structure,such as left, right half side of pelvis. the female pelvis models showed clearly the relationship between the vertebral body and cone arch morphology, regular shape, clear hip; sacral surface smooth, natural radian, bilateral sacral foramen clearly visible, coccyx morphological integrity, sacroiliac joint, sacrococcygeal joint and pubic symphysis legible. The model can be arbitrarily scaled, cutting and rotation at any angle, and can take pictures and animation form is derived for general format. Mimics and ug software could be used for measurement, automatic generation of measuring diameter and angle of the results. The results can be accurate to0.001mm and0.001degrees.in three-dimensional space,we can measure the transverse diameter of pelvic entrance using digital3d models of the pelvis, entrance after sagittal diameter, transverse diameter of pelvis, the middle sagittal diameter, transverse diameter of export, export back sagittal diameter, angle subpubic arch, anteroposterior diameter of pelvic entrance, sacropubic diameter of pelvic outlet, anteroposterior diameter, anteroposterior diameter, pubic symphysis height, length of the sacrum sacral, camber measurement. The measurement method can be repeated, has applied for pelvic measurements.
THE Third Section:Discussion
1.Computer pelvic3D reconstruction which based on CT scanning is the direct use of in vivo data,3D pelvic model reconstruction can not only carry out random scaling, cutting and arbitrary rotation angle, but also can accurately measure directly related diameter of pelvis and angle, reduce the influence of artificial factors in traditional measurement, no tridimensional blind area x-ray measurement, more truly reflect the physiological condition of pelvis.
2. Using Mimics software, obtaining the digital three-dimensional model of vivo data female pelvis, and the Geomagic software and the UG software were used in the study, the original image directly read DICOM format, the measuring function of Mimics software. Measurement of further using Mimics software three-dimensional measurement and3D angle measuring tools in the pelvis model reconstruction of related to the clinical commonly used diameter and angle.
3.Using Mimics software3d lines and3d measurement Angle measurement tool can be in a good pelvic reconstruction model for clinical commonly used related to diameter of line and Angle measurement.
4.The method of three-dimensional reconstruction and measurement of all the operation directly on a computer, is easy to popularize and complete the acquisition of large quantities of data work. Convenient in clinical application to establish individual virtual pelvis, providing a technical platform for the relevant research.
Part two
Uighur female pelvic of Xinjiang digital three-dimensional model reconstruction and Pelvic measurement [Objective]
Foreign research shows that:The different nutrition, life, work habits and region may impact the pelvic morphology and characteristic, the pelvic morphology has obvious regional and ethnic characteristics. To understand Xinjiang uygur femal normal pelvic morphology changes. We reconstructed the Xinjiang uygur women's normal pelvic based on CT three-dimensional model reconstruction, measured the pelvic main longitudinal measurement, concluded the modern xinjiang uygur female of child-bearing age physiological constant value of the pelvis, cleared the pelvic fine anatomical features and obstetric physical constants, and we had reconstruct the normal female pelvic successfully before. In the process of measurement, we found that the ratio of tail joint abnormal in the Uighur women is relatively high. So, we measured the detailed morphological and physiological constant of the sacrum.
The first section:materials and methods
1.the research object:From2012January to2013January, in the people's Hospital of Xinjiang autonomous region, Hetian People's Hospital, Yili Xinhua hospital image center, the100Han and100Uighur fertility active women, age25-40years old, mean age (31.6±6.7) years old, were selected. All women living in Xinjiang, the body upright, legs of normal development, and they have at least a full-term pregnancy, vaginal birth history, neonatal birth weight between 2500g-4000g, eliminate pathological pelvis.
2, Software and equipment,3D reconstruction and measurement method was mentioned in the first part. Split the sacrum use the tool of Edit Masks in the Mimics10.01. Create the three-dimensional digital model of the sacrum separately. Sacral digital model into UG software, on the sacrum, sacral camber length, anterior sacral foramina and the posterior sacral foramina transverse diameter, vertical diameter, hole iliac line distance, sacral hiatus width and depth were measured.
4. Statistical methods SPSS13.0statistical software was used for statistical observation of the index, mean and standard deviation of each data.
The second section:the results
1, Using the CT scan raw datac of the Uighur women pelvic and the3D reconstruction technology, and combining the Mimics soft, we can reconstruct the complete pelvis successfully, We can also split the pelvic use the Geomagic software, such as the left and right side of the pelvis and sacrum. The model of the Xinjiang uygur female pelvics were clear, arbitrarily scaling, cut and rotation in any angle. The measurement of bstetric physical constant of pelvic was used Mimics and UG soft, and obtained14physiological constant.
2, The measurement of modern Xinjiang uygur female pelvic obstetric physiological constant and diameter:12physiological diameters and2angles were measured:pelvic entrance diameter (136.70±7.23mm), posterior sagittal diameter (47.67±7.59mm), midpelvis transverse diameter (105.36±6.17mm), midpiece sagittal diameter (42.06±6.40mm), transverse outlet diameter (114.09±0.35mm), transverse outlet sagittal diameter (66.13±9.09mm), pelvic inlet anteroposterior diameter (113.52±7.88mm), the sacral shame inside diameter (124.10±9.87mm), midpelvis anteroposterior diameter (121.22±7.11mm), pelvic outlet anteroposterior diameter (111.27±8.72mm), pubic symphysis height (32.22±3.45mm), length of the sacrum (105.87±9.53mm) and pubic arch angle (90.49±8.44°), sacral camber length (131.73±10.31°).
3, The measurement of modern Xinjiang uygur female morphological characteristics physiological constant of sacrum:In Uigur females,63cases (63.3%) as were the standard type,7cases of sacral had4sacral pass, including2cases of lumbar vertebra and sacral pore was sacralization completely,3cases of lumbar vertebra and sacral pore was sacralization uncompletely,2cases vertebra and sacral pore was lumbarization.10cases (10%) had5sacral pass,20cases (20%) had sacrococcygeal joint abnormalities. We measured the physiological constant of sacrum:length of the sacrum:(4pairs of standard sacral pore:106.6±12.0mm,4pairs of unstandard sacral pore:96.4±11.2mm, The sacrum and coccyx joint abnormalities:116.0±10.2mm). Camber of the sacrum(4pairs of the standard sacral pore:132.8±13.2°,4pairs of the nonstandard sacral pore:135.1±3.9°,5pairs of the sacral pore:134.7±3.7°, the sacrum and coccyx joint abnormalities:160.8±4.2°). The rest of the measurements can be found in the body.
4、Modern characteristics of xinjiang uygur female pelvis type:In100cases of Xinjiang uygur female,42cases(42.0%) were gynecoid type,38cases(38.0%) were platypelloid type,15cases(15.0%) were anthhropoid type,5cases(5.0%) were android type. The gynecoid type and platypelloid type was the most common type.
Third Section:Discussion
1. We reconstructed100cases xinjiang uygur female pelvis successfully based CT original data, using the Mimics soft and digital3-D reconstruction technology. The pelive were flat, smooth, radian nature, and we can observe it in arbitrary rotation. We can also split the pelvic use the Geomagic software, such as the left and right side of the pelvis and sacrum. Three-dimensional measurement of pelvic was used Mimics and UG soft, and obtained14physiological constant.
2.We found that the coccyx upwarp and the sacrum and coccyx joint abnormalities in the xinjiang uygur female was relatively high, the pelvic has its own characteristics.
3. In the pelvic morphology study, we found:The gynecoid type and platypelloid type was the most common type, the anthhropoid type was less and the android type was the least in the xinjiang uygur female.
Part three
Han female pelvic of Xinjiang digital three-dimensional model reconstruction and Pelvic measurement [Objective]
Xinjiang is a multi-ethnic gathering areas, to understand the Xinjiang region of normal Han female pelvic morphology and obstetric physiological constants of characteristics, we use three-dimensional digital reconstruction of digitized measurement technology successfully build on the100cases in the body normal Xinjiang Uygur female pelvis foundation100cases, using the same reconstruction parameters body Xinjiang normal Han female pelvis digitized three-dimensional reconstruction, and reconstruction of the a successful pelvic the obstetric physiological constant measurement, get the modern Xinjiang Han women of childbearing age pelvis obstetric physiological constant value clear pelvis fineanatomical characteristics and the obstetric physiological constant. To get Uighur and Han female pelvis morphological and physiological constants, we also extracted the the Xinjiang Han female pelvis sacrum parts morphological and physiological constant measurement.
[materials and methods] 1.the research object the Han and Uighur child-bearing period women active100cases respectively. The100active period women selected from January2012to January2013, the Maternal and Child Health Hospital in Urumqi, Xinjiang Autonomous Region People's Hospital, the Hotan Prefecture People's Hospital, Xinhua Hospital Imaging Center Yili Prefecture pelvic CT examination Han fertility, age25-40years, mean age (30.1±5.8) years, all women are long-term living in Xinjiang, upright posture, limbs developed normally, and first full-term pregnancy, history of vaginal delivery, birth weight of2500g-4000gbetween exclude pathological pelvis.
2. software and equipment methods of three-dimensional reconstruction and measurement is the same with the first,as mentioned in part one. Other Mimics10.01software tool mask editing (EditM asks) a sacrum with iliac separation, three-dimensional reconstruction build a separate the sacrum digitized three-dimensional model. Import UG software from the length of the sacrum, sacral curvature, the presacral hole and sacral hole transverse diameter, longitudinal diameter, hole iliac line, the width and depth of the sacral hiatus measurements.
3. statistical methods A pelvic measurement data will be obtained, the application SPSS13.0statistical software were used for statistical, obtained data mean and standard deviation.
The second section:the results
1, Female Han pelvic CT scan in the raw data, combined with a digital three-dimensional reconstruction techniques, the use of medicine interactive software Mimics successful reconstruction of the100patients with complete pelvis; Geomagic software were able to rebuild part of the pelvic structures such as a left and right half of the pelvis and sacrum and so on. Reconstruction parameters completely with the same parameters as the Uygur female pelvic reconstruction. Reconstruction out of Han female pelvic model three-dimensional, clearly, each bone signs are clear, can conduct random scaling, cutting and any angle of rotation, followed by Mimics and UG Software female Han digital three-dimensional pelvis model carried obstetric physiological constants of precise measurement.
2, modern Xinjiang Han female pelvis obstetric physiological constant diameter line measurement:Uighur women, each the pelvis measuring a total of12warp:pelvic inlet transverse diameter (131.58±6.61mm), import sagittal diameter (52.90±7.82mm), transverse diameter of the pelvis (104.78±6.93mm), middle sagittal diameter (43.89±5.34mm), export transverse diameter (114.23±8.39mm), export sagittal diameter (67.13±8.51mm), the pelvic inlet anteroposterior diameter (118.44±6.64mm), sacral the shame inside diameter (130.33±8.39mm), in the pelvis anteroposterior diameter (121.26±7.01mm), export anteroposterior diameter (110.87±8.59mm), pubic symphysis height (32.45±2.95mm), sacrum length (108.33±9.50mm)12warp and pubic arch angle (88.52±8.46°), sacral (135.21±11.34°)2camber angle.
3, the modern Xinjiang Han women sacral morphological characteristics and physiological constant determination:100cases of the Han women sacral94patients were in line with the standard anatomical descriptions, no coccyx upturned. Were measured according to the sacrum typing the following sacral physiological constant: the length of the sacrum (four pairs of sacral foramina Standard:102.9±11.8mm;5sacral pass:125.8±13.2mm), sacral curvature (the sacral foramina standard type:134.8±14.6°; of5sacral pass:135.2±3.2°), the presacral hole and sacral hole diameter of longitudinal diameter, the hole iliac line spacing, the sacral hiatus width and depth (measuring the first, second and third, respectively, four sacral foramina, see text).
4, modern Xinjiang Han female pelvis type characteristics:in Xinjiang Han women in 100cases, the main female pelvis,65cases, accounting for65.0%; followed by great apes, in18cases, accounting for18.0%; the flat pelvis rare,13cases, accounting for13.0%; male pelvis is the most rare,4cases, accounting for4.0%.. The most common female and apes pelvis.
The Third Section:Discussion
1,Based on the early application of digital three-dimensional reconstruction and measurement techniques Xinjiang modern Uighur women pelvic reconstruction and measurement based on100cases,100cases Xinjiang Han women CT raw data, combined with medical interactive software Mimics, with Uighur women pelvic reconstructive same parameters, the successful reconstruction of the100cases of complete Xinjiang region the modern Uyghur Han female pelvis, strong sense of three-dimensional reconstruction of the pelvis and the anatomic landmarks clearly arbitrary angle rotation, scaling, segmentation and measurement.
2,Using Geomagic software can be arbitrary separation cutting rebuild part of the pelvis structure such as a left and the right side of the pelvis and sacrum. Mimics and UG software for three-dimensional measurements of the pelvis, a total of14obstetric physiological constant measurement.
3,Detailed comparison with Uighur female pelvic morphology, and obstetric physiological constant isolate rebuilt Han women sacrum, clear its morphological characteristics, and complete the Determination of Physiological constant of the sacrum. The reconstruction of100cases of female Han the sacrum seen coccyx upturned.
4, In pelvic morphology study found:of Xinjiang modern Han female pelvic morphology mainly female type and apes pelvis, followed by flat type, male-type lowest proportion.
Part four
The pelvic physiological constant comparison study between the Xinjiang Uighur female and Han female [Objective]
The female pelvis is one of the main factors affecting the delivery.The formation and development of the female pelvis is affected by various factors such as climate, nutrition, diet and crafts habits.Along with the economic, cultural and living standards improve, the female pelvis also change. However, our current obstetric traditional clinical remains pelvis data of more than20years ago, and no nation divided.Using digital three-dimensional reconstruction of digitized measurement technology to rebuild the pelvis obstetric physiological constants of various diameter line measured values, the Uighur and Han wome.in this research, in order to highlight the differences between the different ethnic groups, provide a reference for the development of the female pelvic parameters for the region in the development of obstetric diameter line standards.
The first section:materials and methods
1, the object of study
From2012January to2013January, in the people's Hospital of Xinjiang autonomous region, Hetian People's Hospital, Yili Xinhua hospital image center,thel00Han and100Uighur fertility active women,age25-40years old, Uighur group mean age (31.6±6.7) years old, Han group mean age (30.1±5.8) years old were selected.All women living in Xinjiang, the body upright, legs of normal development, and they have at least a full-term pregnancy, vaginal birth history, neonatal birth weight between2500g-4000g, eliminate pathological pelvis. Pelvic diameters is measured and the data was analyzed among the groups.
2. software and equipment:The same with part two and part three.
3.3D reconstruction and measurement method:The same with part two and part three.
4.statistical methods:
4.1The pelvic measurement data obtained from the comparison between the two groups, using the SPSS13.0statistical software for statistical observation index, calculated mean and standard deviation of each group. Among the groups in pelvic morphology,we used the chi-square test (Fisher 's Exact Test),,and independent samples T-test for comparing the pelvic physical constants. if P≤0.05was considered statistically significant difference between groups.
4.2Sacrum measurement data comparison between the two groups:Calculated mean and standard deviation of each group, Between the groups in pelvic morphology,we used the chi-square test (Fisher's Exact Test), and independent samples T-test was used for compare measurement data,if P<0.05was considered statistically significant difference between groups.
The second section:the results
1. Obstetric physiological constant mean diameter line comparison results among Xinjiang Uighur women and Han women.
1.1There is a significant difference among two groups:Two groups in the pelvic inlet plane diameters measured value differences were statistically significant (P<0.05), in the middle of sagittal diameter of the pelvic midplan and the exit plane sacrum camber difference was statistically significant (P<0.05), the rest of the diameter line difference was not statistically significant (P>0.05). The pelvic inlet diameter of Xinjiang Uygur female greater than Han women (P=0.000), but the anteroposterior diameter of the inlet, sagittal diameter of the entrance, the sacral shame diameter less than Han women (P=0.000). in the middle of sagittal diameter of the pelvic midplan of the Uighur female pelvis sagittal diameter of less than Han women (P=0.029) the sacral curvature less than Han women (P=0.024).
2. The sacrum digitized three-dimensional model of the physiological constant measurement results, morphology and comparison between Xinjiang Uighur and Han women
2.1Sacral morphology comparison between Xinjiang Uighur women and the Han women:94of100Han women sacral was accord with standard anatomical description,6cases of sacral5pass. But100cases of Uigur women in63cases (63%) as the standard type;7cases were non standard4pairs of sacral pass, including lumbar sacralization completely in2cases,3cases of lumbar sacral insufficiency, lumbarization in2cases;5of the sacral groove10cases (10%); sacrococcygeal joint abnormal type (including the tailbone upward or coccygeal sacralization type)20cases (20%). By chi-square test, there was significant difference between two minority female sacral morphological categories (x2=37.246, P=0.000).100cases of Uigur women have20people. The coccyx, and Han women were observed (Fig.11-14). There was a significant difference between the two (x,2=22.22, chi-square P=0.000).And compared with the measured results,2Uighur and Han women digital three-dimensional model of sacral physiological constant
2.2Sacrum digitized three-dimensional model of the physiological constant measurement results and comparison between Uighur and Han women:the transverse diameter of Xinjiang Uighur women and Han women around the sacral foramina longitudinal diameter hole iliac line spacing and width of the sacral hiatus difference was not statistically significant (P>0.05); sacrum before and after the hole is deep distance and sacral hiatus depth difference was statistically significant (P<0.05), Uighur women sacrum before and after hole contour interval and the sacral hiatus depth was significantly greater than the Han women. Xinjiang Uighur women and Han women Standard sacrum sacrum length and sacrum angle differences was not statistically significant (P>0.05). Non-standard sacrum fewer cases, basic Uighur women.
3. The proportion of the pelvic type among the Xinjiang Uighur women and Han women.
In100cases of Xinjiang Han women, female type was65cases, accounting for65%; flat type in13cases, accounting for13%; Simian type in18cases, accounting for18%;4cases were male type, accounting for4%. The most common type is female. In Xinjiang100Uighur women, female type was42cases, accounting for42%; flat type in38cases, accounting for38%; Simian type in15cases, accounting for15%;5cases were male type, accounting for5%. The female type and flat type were the most common. By chi-square test, there was a significant difference (χ2=17.583, P=0.000). Flat pelvis of the Xinjiang Uygur women significantly higher proportion of Han women, but the proportion of female pelvic significantly lower than Han women.
THE Third Section:Discussion
1.There are4of14physiological pelvic constants in Xinjiang Uighur women and Han women obvious difference, the4different constants are located at the entrance plane. Uighur women pelvic inlet diameter of greater than Han women around the inlet diameter, sagittal diameter of the entrance, sacral the shame inside diameter smaller than the Han women. The pelvis after middle sagittal diameter of the Uighur women smaller than the female Han, the sacral curvature less than the Han women
2.3D reconstruction and measurement differences in Xinjiang Uighur women and Han women sacrum morphological category. Which Uighur women coccyx upturned ratio is more common than Han women. Xinjiang Uighur women the hole
我国是以汉族为主、多民族组成的国家,其中部分少数民族与汉族并非同一人种,由于遗传的原因,她们的骨骼是有明显的差异。研究表明：骨盆形态及特征会因营养、生活劳作习惯以及地域不同而不同,有着显著的地域性及种族特点。新疆是一个多民族聚居的地区,各民族人种并不相同,其中人数最多的两个民族中汉族则源自蒙古人种,维吾尔族属于高加索及蒙古人种的混血种族。国外研究表明：骨盆径线在不同人种间存在着显著的差异,这也与我国30年前进行的女性骨盆大样本测量研究结果相符。1987年,新疆学者李秀凤等采用手工和X线测量,对100例新疆维吾尔族女性和100例汉族女性的骨盆生理常数进行测量分析,显示两个民族间存在明显差异。此后20多年,国内外基本上没有对新疆地区女性骨盆形态和生理常数进一步研究,并且上述数据源自20多年前的研究,方法局限,代表性并不强。
医学的前进从来是伴随着科学技术的进步,随着影像学技术的发展,国外学者采用电子计算机X射线断层扫描技术(Computed Tomography,CT)及磁共振成像(Magnetic Resonance Imaging,MR)设备进行女性骨盆研究,其不但可以进行产科径线测量,亦可以应用于产前诊断及某些妇科疾病的诊断治疗,但国内在这些方面的研究显著落后于国外。随着我国经济发展、居民生活水平的提高,新疆地区女性骨盆很可能也发生了一定的变化,这些变化是否影响该地区女性骨盆的发育?影响的程度如何?有何临床意义?出于维护民族团结、地区稳定以及减少医疗纠纷的需要,对新疆地区女性骨盆进行深入研究显得十分必要。
工欲善其事必先利其器,寻找一个好的方法进行女性骨盆研究显得尤为重要,关于女性骨盆的最经典的研究方法不可否认是X线测量,但是X线骨盆测量方法受限于拍摄角度和体位的影响,亦存在中骨盆摄片的盲区、二维图片信息量少以及放射线剂量大等问题,临床应用受到一定限制。近年来,随着计算机技术的发展,女性骨盆研究方法也发生了很大变化。在医学领域中,实时数字图像处理技术有着极其广泛的应用前景,其核心技术是三维重建,它是指应用逆向工程软件,将连续二维图像转换成数字化三维模型的理论与方法,采用实时数字图像处理技术研究人体解剖结构是目前最先进的方法之一,国外学者较早开启了这方面的研究。
1982年美国学者Federle MP等首次进行二维CT女性骨盆测量,2003年,法国学者Balleyguier C等首次运用CT扫描数据完成骨盆三维数字化模型重建,并进行部分径线测量,文章认为利用CT重建出来的骨盆三维数字化模型不仅能进行任意角度的观察及测量,而且更容易被临床医生和助产士所理解。目前,国内采用数字化技术对女性骨盆的研究刚刚起步,且主要集中于南方汉族女性,尚未见将该技术应用于维吾尔族、汉族女性骨盆对比研究的报道。新疆地区维吾尔族女性有多次分娩史者较多,具有两次或者两次以上剖宫产手术者较其他地区多见,切口愈合不良时有发生,严格控制剖宫产指征在该地区显得尤为重要,查阅文献我们发现导致上述情况发生的原因除了社会经济、患者观念等非医源性因素外,还包括临床医生对相对头盆不称诊断标准掌握欠准确,导致剖宫产指征扩大化等医源性因素。原有骨盆测量方法有很大的局限性,目前临床上采用骨盆外测量方法只能间接评估骨产道的情况,却不能完成同自然分娩关系密切的骨盆内测量及形态分析。虽然自然分娩过程和产力、软产道、胎头大小都有关,但骨盆是一个更加重要因素,同时骨盆相对固定,借助数字化三维重建技术可以在产前进行更准确详细的评估。
本课题采用数字化三维重建技术构建新疆地区维吾尔族、汉族女性骨盆数字化模型,结合Geomagic软件、UG软件对重建的三维骨盆模型进行随意缩放、切割和任意角度旋转观察,并且直接对骨盆进行相关解剖形态学、产科径线及角度的精确测量,得到具有新疆地区女性特点的、不同民族的骨盆生理常数,指导该地区的妇产科临床。但是由于该研究刚起步,研究样本量较少,研究对象目前仅限于生育活跃期女性,有待在后续研究中进一步扩大样本量及研究对象范围。
第一部分基于CT原始数据的正常在体女性数字化骨盆三维重建及测量
[目的]
数字化三维重建运用于临床需要熟练掌握相关计算机软件的操作,图像数据集采集及存储,有别于临床上一般CT或MRI常规检查数据的存储。基于CT扫描的计算机骨盆三维重建是直接采用的活体数据,能最真实地反映人体的解剖情况。应用女性骨盆CT扫描数据结合医学交互软件Mimics成功构建正常在体女性骨盆数字化三维模型,结合Geomagic软件、UG软件,对重建的三维骨盆模型进行随意缩放、切割和任意角度的旋转,不仅可以直接对骨盆进行相关解剖形态学分类、产科径线及角度的精确测量,而且减少了传统测量中人为因素的影响,更真实地反映了骨盆的生理情况。为妇产科相关疾病的研究、诊断以及治疗提供数字化模型和模拟平台。
第一节：材料与方法
一、数据采集及三维重建
1、数据来源
选取一例盆腔CT扫描数据。患者基本资料：女,31岁,新疆和田市人,身高161cm,体重65kg,孕3产3(均顺产),无骨盆、脊柱及下肢外伤史,无盆腔手术史,临床诊断为子宫肌瘤。
2、设备与软件
德国西门子公司生产的64排双源CT (SOMATOM Definition), Mimics10.01重建软件(Materialise公司,比利时),Geomagic软件、UG软件。
3、CT扫描数据采集
扫描时,嘱患者仰卧位,身体位于床面中央,且正中矢状面与床面垂直,双手抱头,双腿伸直并拢。CT平扫条件为：管电压120kV,管电流220mA,层厚5mm,层间距5mm,扫描范围从第三腰椎上缘至股骨中上段,将坐骨结节全部包含在内,扫描后将图像拆薄至层厚为1.0mm,共406层,并刻碟保存。
4、骨盆三维重建
将拆薄后的平扫期骨盆原始数据导入Mimics10.01软件(Materialise公司,比利时)中,经定位图像、组织图片、内插值处理后,设定骨组织重建阈值为226HU,以显示骨盆结构尽量丰富但不至骨盆“毛糙”为准,阈值上限采用系统默认值；应用Mimics软件中蒙罩编辑(Edit masks)中的涂画(Draw)工具,视缺损程度对坐骨棘、骶骨等处按照CT断层图像进行修饰；经区域增长、3D计算重建出包含部分腰椎及股骨的女性骨盆数字化三维模型；采用光滑按钮,对重建出的骨盆进行光滑处理,增强骨盆模型的真实感和立体感。最后将重建的三维骨盆模型分别以STL和JPG的格式导出。
5、骨盆分割
在Geomagic软件中新建文件,导入全骨盆STL文件,旋转骨盆使其左右对称,用平面裁剪功能,选取“直线”,经骶岬中点与耻骨联合做一直线,进行平面截面,选取并删除右半骨盆,保留左半骨盆,封闭相交面,将左半骨盆以STL格式导出文件。
6、骨盆测量
将全骨盆及左半骨盆的数字化模型分别导入UG软件中,利用全骨盆的数字化三维模型测量骨盆入口横径,入口后矢状径,中骨盆横径,中段后矢状径,出口横径,出口后矢状径,耻骨弓角度；利用右半骨盆的数字化三维模型对骨盆入口前后径,骶耻内径,中骨盆前后径,出口前后径,耻骨联合高度,骶骨长度,骶骨弯度进行测量,以mm为单位(精确到百分位)。由2名经过培训的人员独立进行测量,每个骨盆共测量了12条经线及2个角度(图1-2)。其测量标准参照王淑雯等研究的标准测量据点。
第二节：结果
采用CT扫描的女性骨盆原始数据,利用数字化三维重建技术,结合医学交互软件Mimics可以重建出完整的全骨盆,而且利用Geomagic软件可以选择性的重建出部分骨盆结构,如左、右半侧骨盆。重建的女性骨盆腰椎椎体及锥弓的形态和关系分明,髋骨形态规则、清晰；骶骨表面光滑,弧度自然,双侧骶孔清晰可见,尾骨形态完整,骶髂关节、骶尾关节和耻骨联合清晰可辨。模型可以进行随意缩放、切割和任意角度的旋转,并可以以图片和动画的形式导出,格式通用,便于对其进行进一步的后处理。Mimics和UG软件可以对模型进行三维测量,自动生成显示测量径线和角度的结果。结果可以精确到0.001mm和0.001度。在三维空间内,利用全骨盆的数字化三维模型可以测量骨盆入口横径,入口后矢状径,中骨盆横径,中段后矢状径,出口横径,出口后矢状径,耻骨弓角度；利用右半骨盆的数字化三维模型可以对骨盆入口前后径,骶耻内径,中骨盆前后径,出口前后径,耻骨联合高度,骶骨长度,骶骨弯度进行测量,该测量方法可以多次重复使用,有利于骨盆测量的推广运用。
第三节：结论
1.基于CT扫描的计算机骨盆三维重建是直接采用活体数据,重建的三维骨盆模型不仅可以进行随意缩放、切割和任意角度的旋转,而且可以直接对骨盆进行相关径线和角度的精确测量,减少了传统测量中人为因素的影响,没有X线测量和外测量在中骨盆平面中三维盲区,更真实地反映了骨盆的生理情况。
2.利用Mimics软件,可以获取在体女性骨盆的数字化三维模型,将Geomagic软件及UG软件引入研究中,直接读取DICOM格式的原始图像,完善了Mimics软件的测量功能。
3利用Mimics软件中三维径线测量和三维角度测量工具可以在重建好的骨盆模型中对临床常用的相关径线和角度进行测量。
4该方法使三维重建和测量的所有操作在普通电脑上直接进行,容易普及并完成大批量数据的采集工作。方便在临床应用于建立个体化虚拟骨盆,为妇产科相关研究提供技术平台。
第二部分新疆地区维吾尔族女性数字化骨盆三维重建及生理常数的测定
[目的]
国外研究表明：骨盆形态及特征会因营养、生活劳作习惯以及地域不同而不同,有着显著的地域性及种族特点。为了解新疆地区正常维吾尔族女性骨盆形态的变化,我们在前期构建成功的在体正常女性骨盆数字化三位重建研究的基础上进一步利用CT三维重建和改良的骨盆测量技术对在体新疆正常维吾尔族女性的骨盆进行数字化三维重建,并对重建成功的骨盆进行主要经线的测量,尤其是骨盆的主要产科径线及角度,得出现代新疆维吾尔族育龄女性骨盆的生理常数值,明确其骨盆精细解剖特点及产科生理常数。测量过程中,我们发现维吾尔族女性骶尾关节异常比率较高,专门提取了骶骨部分进行了详细的形态学及生理常数的测量。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的维吾尔族生育活跃期女性100名,年龄25-40岁,平均年龄(31.6±6.7)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有至少一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。
2、软件与设备、三维重建和测量方法：同第一部分。另Mimics10.01软件蒙罩编辑(EditM asks)工具将骶骨同髂骨分离,三维重建构建出单独的骶骨数字化三维模型。将其导入UG软件中,对骶骨长度、骶骨弯度、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度进行测量。
3、统计方法：将获得的骨盆测量数据,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差。
第二节：结果
1、采用CT扫描的维吾尔族女性骨盆原始数据,利用数字化三维重建技术,结合医学交互软件Mimics成功重建出完整的全骨盆；利用Geomagic软件可以选择性的重建出部分骨盆结构,如左、右半侧骨盆。重建出的维吾尔族女性骨盆模型各骨性标志清晰可辨,可以进行随意缩放、切割和任意角度的旋转,用Mimics和UG软件对该数字化三维骨盆模型进行产科生理常数的精确测量。
2、新疆维吾尔族女性骨盆产科生理常数各径线测量：每个骨盆共测量12条经线：骨盆入口横径(136.70±7.23mm),入口后矢状径(47.67±7.59mm),中骨盆横径(105.36±6.17mm),中段后矢状径(42.06±6.40mm),出口横径(114.09±10.35mm),出口后矢状径(66.13±9.09mm),骨盆入口前后径(113.52±7.88mm),骶耻内径(124.10±9.87mm),中骨盆前后径(121.22±7.11mm),出口前后径(111.27±8.72mm),耻骨联合高度(32.22±3.45mm),骶骨长度(105.87±9.53mm)共12条经线及耻骨弓角度(90.49±8.44°),骶骨弯度(131.73±10.31°)2个角度。
3、新疆维吾尔族女性骶骨形态特点及生理常数的测定：100例维吾尔族女性中有63例(63%)为标准型；有7例为非标准4对骶孔型,其中包括腰椎完全骶化2例,腰椎不全骶化3例,骶椎腰化2例；5对骶孔型有10例(10%)；骶尾关节异常型(包括尾骨上翘型或尾骨骶化型)有20例(20%)。按照骶骨分型分别测量了以下骶骨生理常数：骶骨长度(4对骶孔标准型：106.6±12.0mm；4对骶孔非标准型：96.4±11.2mm；5对骶孔型：126.6±12.7mm骶尾关节异常型：116.0±10.2mm)、骶骨弯度(4对骶孔标准型：132.8±13.20；4对骶孔非标准型135.1±3.90；5对骶孔型：134.7±3.7°；骶尾关节异常型：160.8±4.20)、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度(分别测量第一、二、三、四骶孔,见正文)。
4、现代新疆维吾尔族女性骨盆类型特点：在100例新疆维吾尔族女性中,女型42例,占42.0%；扁平型38例,占38.0%；类人猿型15例,占15.0%；男型5例,占5.0%。以女型和扁平型最常见。
第三节：结论
1.基于CT原始数据,结合医学交互软件Mimics,应用数字化三维重建技术成功重建出100例完整的新疆地区现代维吾尔族女性的骨盆,重建的骨盆平整、光滑,弧度自然,可任意角度旋转观察。利用Geomagic软件可以任意分离切割重建部分骨盆结构,如左、右半侧骨盆及骶骨。Mimics和UG软件对骨盆进行三维测量,共测量14个生理常数。
2.测量中发现新疆地区维吾尔族女性尾骨上翘比率较高,骶尾关节变异者较多,具有自己的特点。
3.在骨盆形态研究中发现：维吾尔族女性以女型和扁平型骨盆为主,类人猿型次之,男型比例最低。
第三部分新疆地区汉族女性数字化骨盆三维重建及生理常数的测定
[目的]
新疆是多民族聚集地区,为了解新疆地区正常汉族女性骨盆形态及产科生理常数的特点,我们在前期利用数字化三维重建技术和数字化测量技术成功构建100例在体正常新疆维吾尔族女性骨盆的基础上,采用相同重建参数对100例在体新疆正常汉族女性的骨盆进行数字化三维重建,并对重建成功的骨盆进行产科生理常数的测量,得到现代新疆汉族育龄女性骨盆的产科生理常数值,明确骨盆精细解剖特点及产科生理常数。为了下一步维吾尔族和汉族女性骨盆形态学及生理常数的详细比较,我们也提取了新疆汉族女性骨盆骶骨部分进行形态学及生理常数的测量。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的汉族生育活跃期女性100名,年龄25-40岁,平均年龄(30.1±5.8)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。
2、软件与设备、三维重建和测量方法：同第一部分。另Mimics10.01软件蒙罩编辑(EditM asks)工具将骶骨同髂骨分离,三维重建构建出单独的骶骨数字化三维模型。将其导入UG软件中,对骶骨长度、骶骨弯度、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度进行测量。
3、统计方法：将获得的骨盆测量数据,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差。
第二节：结果
1、将CT扫描的汉族女性骨盆原始数据,结合数字化三维重建技术,利用医学交互软件Mimics成功重建出100例完整的全骨盆；利用Geomagic软件能够任意重建部分骨盆结构,如左、右半侧骨盆、骶骨等。重建参数完全与维吾尔族女性骨盆重建参数相同。重建出的汉族女性骨盆模型立体、清晰,各骨性标志清楚,可以进行随意缩放、切割和任意角度的旋转,随后用Mimics和UG软件对汉族女性数字化三维骨盆模型进行产科生理常数的精确测量。
2、新疆汉族女性骨盆产科生理常数各径线测量：与维吾尔族女性相同,每个骨盆共测量12条经线：骨盆入口横径(131.58±6.61mm),入口后矢状径(52.90±7.82mm),中骨盆横径(104.78±6.93mm),中段后矢状径(43.89±5.34mm),出口横径(114.23±8.39mm),出口后矢状径(67.13±8.51mm),骨盆入口前后径(118.44±6.64mm),骶耻内径(130.33±8.39mm),中骨盆前后径(121.26±7.01mm),出口前后径(110.87±8.59mm),耻骨联合高度(32.45±2.95mm),骶骨长度(108.33±9.50mm)共12条经线及耻骨弓角度(88.52±8.46°),骶骨弯度(135.21±11.34°)2个角度。
3、新疆汉族女性骶骨形态特点及生理常数的测定：100例汉族女性骶骨94例均为符合解剖学描述的标准型,未见尾骨上翘情况。按照骶骨分型分别测量了以下骶骨生理常数：骶骨长度(4对骶孔标准型：102.9±11.8mm；5对骶孔型：125.8±13.2mm)、骶骨弯度(4对骶孔标准型：134.8±14.6°；5对骶孔型：135.2±3.2°)、骶前孔及骶后孔的横径、纵径、孔髂线距、骶裂孔宽度及深度(分别测量第一、二、三、四骶孔,见正文)。
4、新疆汉族女性骨盆类型特点：在100例新疆汉族女性中,女型骨盆为主,65例,占65.0%;其次是类人猿型,18例,占18.0%；扁平型骨盆较少见,13例,占13.0%；男型骨盆最少见,4例,占4.0%。。以女型和类人猿型骨盆最常见。
第三节：结论
1.在前期应用数字化三维重建及测量技术完成100例新疆维吾尔族女性骨盆重建和测量的基础上,我们将100例新疆地区汉族女性CT原始数据,结合医学交互软件Mimics,采用同维吾尔族女性骨盆重建的相同参数,也成功重建出100例完整的新疆地区维吾尔汉族女性的骨盆,重建的骨盆三维立体感强,各解剖标志清晰,可任意角度旋转、缩放、分割及测量。
2.利用Geomagic软件可以任意分离切割重建部分骨盆结构,如左、右半侧骨盆及骶骨。Mimics和UG软件对骨盆进行三维测量,共完成了产科14个生理常数测量。
3.为与维吾尔族女性骨盆形态学及产科生理常数进行详细比较,也单独分离重建了汉族女性的骶骨,明确其形态特点,并完成骶骨生理常数的测定。重建的100例汉族女性骶骨未见尾骨上翘情况。
4.在骨盆形态研究中发现：新疆现代汉族女性骨盆形态以女型和类人猿型骨盆为主,扁平型次之,男型比例最低。
第四部分新疆地区维吾尔族汉族女性骨盆生理常数对比研究
[目的]
女性骨盆是影响分娩的主要因素之一,女性骨盆的形成及发育受气候、营养、饮食及劳作习惯等多方面因素的影响,随着经济、文化和生活水平的提高,女性骨盆也在发生变化。但我国目前产科临床上沿用的仍是20多年前的骨盆数据,并且没有民族之分。本研究对利用数字化三维重建技术及数字化测量技术重建成功的维吾尔族、汉族女性骨盆产科生理常数各径线测量数值进行对比,以期在制定产科径线标准上,突出不同民族间的差异性,为制定适合该地区女性骨盆参数提供参考。
第一节：材料与方法
1、研究对象
选取自2012年1月至2013年1月,在乌鲁木齐市妇幼保健院、新疆自治区人民医院、和田地区人民医院、伊犁州新华医院影像中心行盆腔CT检查的汉族及维吾尔族生育活跃期女性各100名,分别为新疆维吾尔族组、新疆汉族组,年龄25-40岁,维族平均年龄((31.6±6.7))岁,汉族平均年龄(30.1±5.8)岁,所有女性均长期生活于新疆,体态端正,四肢发育正常,并有至少一次足月妊娠,经阴道分娩史,新生儿出生体重在2500g-4000g之间,排除病理骨盆。对其骨盆进行主要径线的测量,并对数据进行对比分析。
2、软件与设备：同第二、第三部分。
3、三维重建和测量方法：同第二、第三部分。
4、统计方法：
4.1将获得的两组骨盆测量数据进行比较,应用SPSS13.0统计软件对观察指标进行统计,求出各组数据的均值及标准差,两组间骨盆形态的比较采用卡方检验(Fisher's Exact Test),骨盆生理常数的比较采用独立样本T检验,若P≤0.05则认为对比组间差异有统计学意义。
4.2骶骨测量数据两组之间的比较：求出各组数据的均值及标准差,两组间骶骨形态的比较采用卡方检验(Fisher's Exact Test),两组间计量资料的比较采用独立样本T检验,若P≤0.05则认为对比组间差异有统计学意义。
第二节结果
1、新疆维吾尔族女性和汉族女性骨盆产科生理常数各径线值的比较结果两组在骨盆入口平面的各条径线测量值的差异均有统计学意义(均P<0.05),中骨盆平面的中段后矢状径和出口平面的骶骨弯度差异有统计学意义(均P<0.05),其余各条经线差异均无统计学意义(均P>0.05)。新疆维吾尔族女性骨盆入口横径大于汉族女性(P=0.000),而入口前后径、入口后矢状径、骶耻内径均小于汉族女性(均P=0.000)。维吾尔族女性骨盆中段后矢状径小于汉族女性(P=0.029),骶骨弯度小于汉族女性(P=0.024)。
2、新疆维吾尔族和汉族女性骶骨数字化三维模型生理常数的测量结果、形态及比较
2.1新疆维吾尔族女性和汉族女性骶骨形态及比较：100例汉族女性骶骨94例均为符合解剖学描述的标准型,6例为5对骶孔型。100例维吾尔族女性中有63例(63%)为标准型；有7例为非标准4对骶孔型,其中包括腰椎完全骶化2例,腰椎不全骶化3例,骶椎腰化2例；5对骶孔型有10例(10%)；骶尾关节异常型(包括尾骨上翘型或尾骨骶化型)有20例(20%)。经卡方检验,两个民族女性之间骶骨形态类别有显著性差异(χ2=37.246,P=0.000)。100例维吾尔族女性有20人存在尾骨上翘情况,而汉族女性中未见。二者间存在显著差异(χ2=22.22,P=0.000)。
2.2维吾尔族和汉族女性骶骨数字化三维模型生理常数的测量结果及比较：新疆维吾尔族女性与汉族女性前后骶孔横径、纵径及孔髂线距及骶裂孔宽度的差异无统计学意义(P>0.05)；但骶骨前后孔深距及骶裂孔深度方面差异有统计学意义(P<0.05),维吾尔族女性骶骨前后孔深距及骶裂孔深度显著大于汉族女性。新疆维吾尔族女性及汉族女性的标准型骶骨在骶骨长度及骶骨角度方面差异无统计学意义(P>0.05)。非标准型骶骨例数较少,且基本出现在维吾尔族女性中。
3、新疆维吾尔族女性和汉族女性骨盆类型的比例
在100例新疆维吾尔族女性中,女型42例,占42.0%；扁平型38例,占38.0%；类人猿型15例,占15.0%；男型5例,占5.0%。以女型和扁平型最常见。在100例新疆汉族女性中,女型65例,占65.0%；扁平型13例,占13.0%；类人猿型18例,占18.0%；男型4例,占4.0%。以女型最常见。经卡方检验,两组骨盆类型分布有统计学差异(χ2=17.583,P=0.000)。新疆维吾尔族女性扁平型骨盆比例显著高于汉族女性,但女型骨盆比例显著低于汉族女性。
第三节结论
1、新疆地区维吾尔族女性和汉族女性所测量的14个生理常数有6个存在显著差异,其中4个有差异的常数位于入口平面。新疆维吾尔族女性骨盆入口横径大于汉族女性,而入口前后径、入口后矢状径、骶耻内径均小于汉族女性。维吾尔族女性骨盆中段后矢状径小于汉族女性,骶骨弯度小于汉族女性。
2、在三维重建和测量时发现新疆维吾尔族女性和汉族女性骶骨形态类别差异明显。其中,维吾尔族女性尾骨上翘比例较汉族女性常见。维吾尔族女性骶骨前后孔深距及骶裂孔深度明显大于汉族女性。新疆维吾尔族女性非标准型骶骨例数较汉族女性多。骶椎裂、腰椎骶化或骶椎腰化等骶骨变异的情况多存于维吾尔族女性中。
本研究中骶尾关节异常的维吾尔族女性均有阴道分娩史,与经典产科理论中的难产标志相悖。这些结果提示维吾尔族女性骶骨有其自身的特点。
3、两组间骨盆形态分析显示：新疆汉族女性以女型骨盆为主,其次是类人猿型,扁平型骨盆较少见,男型骨盆最少见。维吾尔族女性中女型和扁平型骨盆均较多,类人猿型较少见,男型骨盆最少见。维吾尔族女性扁平型骨盆比例明显高于汉族女性。
上述产科生理常数测量对比结果显示：新疆维吾尔族女性骨盆有其自身的特点,与汉族女性骨盆之间存在一定差异。因此,在制定产科径线标准上,要考虑到不同民族间的差异性。
全文小结
1、应用在体女性骨盆CT扫描数据结合医学交互软件Mimics, Geomagic和UG软件成功构建出正常女性数字化骨盆三维模型,重建的三维骨盆模型不仅可以进行随意放缩和任意角度的旋转,而且可以直接对骨盆进行相关解剖形态学研究及产科径线及角度的精确测量。
2、收集100例在体维吾尔族女性骨盆CT原始数据集,成功地构建出正常维吾尔族女性数字化骨盆三维模型,并进行了精确测量。结果发现维吾尔族女性尾骨上翘比例较高,骶尾关节异常比例较高,具有自己的特点。
3、采用相同重建参数,完成100例汉族女性数字化骨盆三维模型重建和生理常数的精确测量。
4、维吾尔族、汉族女性各100例骨盆测量数据对比发现：新疆地区维吾尔族女性和汉族女性所测量的14个生理常数有6个存在显著差异,其中4个有差异的常数位于入口平面。
5、新疆维吾尔族和汉族骶骨形态及生理常数测量时发现：新疆维、汉两个民族女性差异明显。其中,维吾尔族女性尾骨上翘比例较汉族女性常见。维吾尔族女性骶骨前后孔深距及骶裂孔深度明显大于汉族女性。新疆维吾尔族女性非标准型骶骨例数较汉族女性多。骶椎裂、腰椎骶化或骶椎腰化等骶骨变异的情况多存于维吾尔族女性中。
6、在骨盆形态上,新疆汉族女性以女型骨盆为主,其次是类人猿型,扁平型骨盆较少见,男型骨盆最少见。维吾尔族女性中女型和扁平型骨盆均较多,类人猿型较少见,男型骨盆最少见。维吾尔族女性扁平型骨盆比例明显高于汉族女性。
本研究结果显示：①基于CT原始数据的骨盆数字化三维重建及测量技术减少了传统X线测量、临床外测量中人为因素的影响,更真实地反映了骨盆的生理情况,是研究骨盆的理想模型,为相关研究提供了技术平台。②新疆维吾尔族女性骨盆有其自身的特点,与汉族女性骨盆之间存在一定差异。因此,在制定产科径线标准上,要考虑到不同民族间的差异性。
The pelvis is an important component in the human skeletal system, in women, the pelvis is closely related to pregnancy, childbirth and various gynecological diseases. Pelvis is playing an important role in human body.Due to the limitations of the research methods, it has been unable to depth understanding. Since1895the X-ray was discovered, Scholars at home and abroad have found an increasingly wide utilization in pelvic measurement. Chinese scholars begined to focus on the female pelvis since the50's of last century. In the following30years, They finished a large-scale study in pelvic measurement by X-ray and mde a great contribution to the clinical obstetrics. From1983to1985, Shuwen-Wang and Lian Yue et al organized and coordinated the female pelvic measurement work flow. The following three years, data collected were analysed and statistics were released finally. The research has thrown up some differengts between the Han and Uighur women pelvis, but the research had focused on the300women In the Tianshan Mountain and Manas County. Great changes have taken place in the social culture, economy, life habit, but the research on the pelvic measurement stagnated. Foreign research shows that the female pelvis morphology and diameter have changed enormously over the last20or30years. The overall trend of these changes is not conducive to the natural delivery. Nowadays, The clinical data of female pelvis without the ethnic and regional differences originate from the "information" twenty years ago.
Xinjiang is a multi-ethnic region inhabited by different races. Uighur ethnic group is a Mixed race by the Caucasus and Mongolia while Han belongs to the Mongolia race.According to foreign theory and practice, There were significant differences in pelvic diameters among different species and the result is agreeable with one by chinese scholars. In1987, one hundred Uighur women pelvises and one hundred Han female pelvises were measured and their characteristics were analyzed by Xiufeng-Li. There were significant differences between group Uighur women and group Han female. After20years, there was no further study on the female pelvis in Xinjiang area. The study cannot fully represents Xinjiang female pelvis now for its time too long, meanwhile200women is quite a small sample, so the results should be treated cautiously.
With the development of computer technology and computer graphics, medical imaging technology has a great improvement. CT and MR were used for female pelvic research, including Obstetric diameter measurement, noninvasive prenatal diagnosis and some gynecological diseases diagnosis and treatment. China lags behind other nations in the field of scientific study. As China's economic development and the living standards of residents upgrading, the pelvis maybe probably change, how to evaluate these effects and what is its significance clinically? That is a question. For the purpose of promoting national reunification, ethnic unity,social stability and reducing medical disputes, it's necessary to an in depth study of the female pelvis in Xinjiang area.
A workman must sharpen his tools if he is to do his work well. The classical method is X-ray pelvimetry. Due to the influence of shooting angle and patient position, pelvic midplane blind zone, two-dimensional pictures, large amounts of radiation, there exists defects in X-ray pelvimetry. In recent years, the female pelvic research method already changed with computer development. The real-time image processing technology has extensive application foreground in medicine area. The core technology is3D reconstruction. This method changes two-dimensional images into three-dimensional model with the help of reverse engineering software. In a word, The real-time image processing technology is a state-of-art anatomical research method.
China is a country with Han nationality as the main body, multi-ethnic country, Part of minority and Han nationality is not the same. Due to the nutrition, living and working habits and regional difference, pelvic diameter has regional and ethnic characteristics significantly.By using digital technology, Research on female pelvis which focus on the Southern Chinese Han women has just started. The technique is not applied to the comparative study between Uighur women and Han women yet. Uighur women in xinjiang area have more multiple delivery history. The rate of repeat cesarean section is higher than that of other areas, and therefore the rate of bad healing of incision is higher. Strictly control the indications for cesarean section is particularly important in the region. Besides the objective factors and social economy, also includes the clinicians in relative cephalopelvic disproportion standard master less accurate. The original pelvic methods have great limitations. Current clinical pelvis measurement method only provide an indirect evaluation of bony. Internal pelvimetry and pelvic morphology are closely associated with the natural childbirth, but these cannot be evaluated now. With the help of three-dimensional reconstruction of digital technology, pelvic factor can be more accurate and detailed assessment.
With the help of geomagic software and ug software,this subject adopting digital three-dimensional reconstruction technique made the digital pelvimetry possible. We have received many data of pelvimetry for our research into the female pelvis in Xinjiang area. Taking into account the differences of nationalities, regions is very important in clinical practice. As for the small amount of sample and the age limitations, more accurate and comprehensive data would be left behind to further research.
Part one:Based on digital Three-Dimensional reconstruction and measurement in vivo CT raw data of the normal female pelvic
[Objective]
Three-dimensional digital reconstruction used in clinical is called for mastering the relevant computer software operation, image data acquisition and storage, it is different from the general clinical CT or MRI routine data storage. Computer pelvic3D reconstruction based on CT scanning is used in vivo data directly, can most reflect the anatomy of human body.Application of female pelvic CT scan data combined with the software Mimics to construct medical interaction in female pelvic three-dimensional digital model, combined with Geomagic software, UG software,3D pelvic model for reconstruction of the random scaling, cutting and arbitrary rotation angle, not only can accurately measure directly related morphological anatomy, obstetric diameter and angle of the pelvis, but also of gynecological preoperative evaluation, operation simulation is used to reduce the human factor influence, the traditional measurement, more truly reflect the physiological condition of pelvis.Digital model and simulation platform for female obstetrics and gynecology diseases, diagnosis and treatment.
The first section:materials and methods
1.Sources of cases:Select one pelvic CT scan data. Patients basic information:female,31years old, and xinjiang hotan city people, height161cm, weight65kg, pregnant3delivery3(all natural), there is no history of pelvis and spine and lower extremity trauma, there is no history of pelvic surgery, clinical diagnosis of uterine fibroids.
2. Equipment and software
Dual-source spiral CT with64rows (SOMATOM Definition German Siemens company), Mimics10.01software (Materialise's interactive medical image control system), Geomagic software, UG reconstruction software.
3.CT raw data acquisition
The patient were scanned by dual-source spiral CT with64rows.the patients were told to keep themselves in supine position, the body in the bed center, and the median sagittal plane and perpendicular to the bed surface, both hands to hold the head, legs straight and close together. CT scanning condition:tube voltage120kV, tube current220mA, thickness5mm, interval5mm, range from the third lumbar vertebra to the superior border of the femur, the ischial tuberosity all included, the layer thickness is1.0mm.
4, Three-Dimensional Reconstruction
The scanning data of pelvis were imported into Mimics10.01software (Materialise, Belgium), organized by the positioning, then set the bone tissue reconstruction threshold226HU, to display the pelvic structure to be rich but not to the pelvis "hair brown" shall prevail, upper threshold using the system default application of Mimics software in value; Mask editor (Edit masks) in the paint (Draw) tools, visual impairment to the ischial spine, sacrum, according to the CT tomographic images were modified by3D calculation; regional growth, reconstructed the female pelvis three-dimensional digital model contains part of femur and lumbar spine, smoothed,enhance the sense of reality of pelvic model and three-dimensional sense.Finally,3D pelvic model were exported in STL and JPG format.
S.Split The Three-Dimensional Digital Model
Create a new file in Geomagic software, import the whole pelvic STL file, rotate pelvis make it symmetrical, with plane cutting function, select the "line", the sacral promontory point and pubic symphysis do a straight line, plane section, select and delete the right half pelvis, retain the left pelvis, closed intersecting planes, export the left pelvis at STL format file.
6. Pelvic measurement
The digital model of the whole pelvis and left pelvis were respectively imported into UG software, using whole pelvic digital3D models for measuring transverse diameter of pelvic entrance, entrance after sagittal diameter, transverse diameter of pelvis, the middle sagittal diameter, transverse diameter of export, export back sagittal diameter, angle subpubic arch, the right pelvis for the anteroposterior diameter of the pelvic entrance, sacropubic diameter of pelvic outlet, anteroposterior diameter, anteroposterior diameter, pubic symphysis height, length of the sacrum sacral, camber measurement,(with the unit of mm). each pelvis were measured12lines of longitude and2angles (Fig.1-2).The measurement standard by Shuwen-Wang of standard measurement sites.
The second section:the results
The CT scanning data of the Uighur, Han female pelvic, combined with the Mimics software, can reconstruct pelvic integrity, and using Geomagic software, we can selectively reconstruct part of pelvic structure,such as left, right half side of pelvis. the female pelvis models showed clearly the relationship between the vertebral body and cone arch morphology, regular shape, clear hip; sacral surface smooth, natural radian, bilateral sacral foramen clearly visible, coccyx morphological integrity, sacroiliac joint, sacrococcygeal joint and pubic symphysis legible. The model can be arbitrarily scaled, cutting and rotation at any angle, and can take pictures and animation form is derived for general format. Mimics and ug software could be used for measurement, automatic generation of measuring diameter and angle of the results. The results can be accurate to0.001mm and0.001degrees.in three-dimensional space,we can measure the transverse diameter of pelvic entrance using digital3d models of the pelvis, entrance after sagittal diameter, transverse diameter of pelvis, the middle sagittal diameter, transverse diameter of export, export back sagittal diameter, angle subpubic arch, anteroposterior diameter of pelvic entrance, sacropubic diameter of pelvic outlet, anteroposterior diameter, anteroposterior diameter, pubic symphysis height, length of the sacrum sacral, camber measurement. The measurement method can be repeated, has applied for pelvic measurements.
THE Third Section:Discussion
1.Computer pelvic3D reconstruction which based on CT scanning is the direct use of in vivo data,3D pelvic model reconstruction can not only carry out random scaling, cutting and arbitrary rotation angle, but also can accurately measure directly related diameter of pelvis and angle, reduce the influence of artificial factors in traditional measurement, no tridimensional blind area x-ray measurement, more truly reflect the physiological condition of pelvis.
2. Using Mimics software, obtaining the digital three-dimensional model of vivo data female pelvis, and the Geomagic software and the UG software were used in the study, the original image directly read DICOM format, the measuring function of Mimics software. Measurement of further using Mimics software three-dimensional measurement and3D angle measuring tools in the pelvis model reconstruction of related to the clinical commonly used diameter and angle.
3.Using Mimics software3d lines and3d measurement Angle measurement tool can be in a good pelvic reconstruction model for clinical commonly used related to diameter of line and Angle measurement.
4.The method of three-dimensional reconstruction and measurement of all the operation directly on a computer, is easy to popularize and complete the acquisition of large quantities of data work. Convenient in clinical application to establish individual virtual pelvis, providing a technical platform for the relevant research.
Part two
Uighur female pelvic of Xinjiang digital three-dimensional model reconstruction and Pelvic measurement [Objective]
Foreign research shows that:The different nutrition, life, work habits and region may impact the pelvic morphology and characteristic, the pelvic morphology has obvious regional and ethnic characteristics. To understand Xinjiang uygur femal normal pelvic morphology changes. We reconstructed the Xinjiang uygur women's normal pelvic based on CT three-dimensional model reconstruction, measured the pelvic main longitudinal measurement, concluded the modern xinjiang uygur female of child-bearing age physiological constant value of the pelvis, cleared the pelvic fine anatomical features and obstetric physical constants, and we had reconstruct the normal female pelvic successfully before. In the process of measurement, we found that the ratio of tail joint abnormal in the Uighur women is relatively high. So, we measured the detailed morphological and physiological constant of the sacrum.
The first section:materials and methods
1.the research object:From2012January to2013January, in the people's Hospital of Xinjiang autonomous region, Hetian People's Hospital, Yili Xinhua hospital image center, the100Han and100Uighur fertility active women, age25-40years old, mean age (31.6±6.7) years old, were selected. All women living in Xinjiang, the body upright, legs of normal development, and they have at least a full-term pregnancy, vaginal birth history, neonatal birth weight between 2500g-4000g, eliminate pathological pelvis.
2, Software and equipment,3D reconstruction and measurement method was mentioned in the first part. Split the sacrum use the tool of Edit Masks in the Mimics10.01. Create the three-dimensional digital model of the sacrum separately. Sacral digital model into UG software, on the sacrum, sacral camber length, anterior sacral foramina and the posterior sacral foramina transverse diameter, vertical diameter, hole iliac line distance, sacral hiatus width and depth were measured.
4. Statistical methods SPSS13.0statistical software was used for statistical observation of the index, mean and standard deviation of each data.
The second section:the results
1, Using the CT scan raw datac of the Uighur women pelvic and the3D reconstruction technology, and combining the Mimics soft, we can reconstruct the complete pelvis successfully, We can also split the pelvic use the Geomagic software, such as the left and right side of the pelvis and sacrum. The model of the Xinjiang uygur female pelvics were clear, arbitrarily scaling, cut and rotation in any angle. The measurement of bstetric physical constant of pelvic was used Mimics and UG soft, and obtained14physiological constant.
2, The measurement of modern Xinjiang uygur female pelvic obstetric physiological constant and diameter:12physiological diameters and2angles were measured:pelvic entrance diameter (136.70±7.23mm), posterior sagittal diameter (47.67±7.59mm), midpelvis transverse diameter (105.36±6.17mm), midpiece sagittal diameter (42.06±6.40mm), transverse outlet diameter (114.09±0.35mm), transverse outlet sagittal diameter (66.13±9.09mm), pelvic inlet anteroposterior diameter (113.52±7.88mm), the sacral shame inside diameter (124.10±9.87mm), midpelvis anteroposterior diameter (121.22±7.11mm), pelvic outlet anteroposterior diameter (111.27±8.72mm), pubic symphysis height (32.22±3.45mm), length of the sacrum (105.87±9.53mm) and pubic arch angle (90.49±8.44°), sacral camber length (131.73±10.31°).
3, The measurement of modern Xinjiang uygur female morphological characteristics physiological constant of sacrum:In Uigur females,63cases (63.3%) as were the standard type,7cases of sacral had4sacral pass, including2cases of lumbar vertebra and sacral pore was sacralization completely,3cases of lumbar vertebra and sacral pore was sacralization uncompletely,2cases vertebra and sacral pore was lumbarization.10cases (10%) had5sacral pass,20cases (20%) had sacrococcygeal joint abnormalities. We measured the physiological constant of sacrum:length of the sacrum:(4pairs of standard sacral pore:106.6±12.0mm,4pairs of unstandard sacral pore:96.4±11.2mm, The sacrum and coccyx joint abnormalities:116.0±10.2mm). Camber of the sacrum(4pairs of the standard sacral pore:132.8±13.2°,4pairs of the nonstandard sacral pore:135.1±3.9°,5pairs of the sacral pore:134.7±3.7°, the sacrum and coccyx joint abnormalities:160.8±4.2°). The rest of the measurements can be found in the body.
4、Modern characteristics of xinjiang uygur female pelvis type:In100cases of Xinjiang uygur female,42cases(42.0%) were gynecoid type,38cases(38.0%) were platypelloid type,15cases(15.0%) were anthhropoid type,5cases(5.0%) were android type. The gynecoid type and platypelloid type was the most common type.
Third Section:Discussion
1. We reconstructed100cases xinjiang uygur female pelvis successfully based CT original data, using the Mimics soft and digital3-D reconstruction technology. The pelive were flat, smooth, radian nature, and we can observe it in arbitrary rotation. We can also split the pelvic use the Geomagic software, such as the left and right side of the pelvis and sacrum. Three-dimensional measurement of pelvic was used Mimics and UG soft, and obtained14physiological constant.
2.We found that the coccyx upwarp and the sacrum and coccyx joint abnormalities in the xinjiang uygur female was relatively high, the pelvic has its own characteristics.
3. In the pelvic morphology study, we found:The gynecoid type and platypelloid type was the most common type, the anthhropoid type was less and the android type was the least in the xinjiang uygur female.
Part three
Han female pelvic of Xinjiang digital three-dimensional model reconstruction and Pelvic measurement [Objective]
Xinjiang is a multi-ethnic gathering areas, to understand the Xinjiang region of normal Han female pelvic morphology and obstetric physiological constants of characteristics, we use three-dimensional digital reconstruction of digitized measurement technology successfully build on the100cases in the body normal Xinjiang Uygur female pelvis foundation100cases, using the same reconstruction parameters body Xinjiang normal Han female pelvis digitized three-dimensional reconstruction, and reconstruction of the a successful pelvic the obstetric physiological constant measurement, get the modern Xinjiang Han women of childbearing age pelvis obstetric physiological constant value clear pelvis fineanatomical characteristics and the obstetric physiological constant. To get Uighur and Han female pelvis morphological and physiological constants, we also extracted the the Xinjiang Han female pelvis sacrum parts morphological and physiological constant measurement.
[materials and methods] 1.the research object the Han and Uighur child-bearing period women active100cases respectively. The100active period women selected from January2012to January2013, the Maternal and Child Health Hospital in Urumqi, Xinjiang Autonomous Region People's Hospital, the Hotan Prefecture People's Hospital, Xinhua Hospital Imaging Center Yili Prefecture pelvic CT examination Han fertility, age25-40years, mean age (30.1±5.8) years, all women are long-term living in Xinjiang, upright posture, limbs developed normally, and first full-term pregnancy, history of vaginal delivery, birth weight of2500g-4000gbetween exclude pathological pelvis.
2. software and equipment methods of three-dimensional reconstruction and measurement is the same with the first,as mentioned in part one. Other Mimics10.01software tool mask editing (EditM asks) a sacrum with iliac separation, three-dimensional reconstruction build a separate the sacrum digitized three-dimensional model. Import UG software from the length of the sacrum, sacral curvature, the presacral hole and sacral hole transverse diameter, longitudinal diameter, hole iliac line, the width and depth of the sacral hiatus measurements.
3. statistical methods A pelvic measurement data will be obtained, the application SPSS13.0statistical software were used for statistical, obtained data mean and standard deviation.
The second section:the results
1, Female Han pelvic CT scan in the raw data, combined with a digital three-dimensional reconstruction techniques, the use of medicine interactive software Mimics successful reconstruction of the100patients with complete pelvis; Geomagic software were able to rebuild part of the pelvic structures such as a left and right half of the pelvis and sacrum and so on. Reconstruction parameters completely with the same parameters as the Uygur female pelvic reconstruction. Reconstruction out of Han female pelvic model three-dimensional, clearly, each bone signs are clear, can conduct random scaling, cutting and any angle of rotation, followed by Mimics and UG Software female Han digital three-dimensional pelvis model carried obstetric physiological constants of precise measurement.
2, modern Xinjiang Han female pelvis obstetric physiological constant diameter line measurement:Uighur women, each the pelvis measuring a total of12warp:pelvic inlet transverse diameter (131.58±6.61mm), import sagittal diameter (52.90±7.82mm), transverse diameter of the pelvis (104.78±6.93mm), middle sagittal diameter (43.89±5.34mm), export transverse diameter (114.23±8.39mm), export sagittal diameter (67.13±8.51mm), the pelvic inlet anteroposterior diameter (118.44±6.64mm), sacral the shame inside diameter (130.33±8.39mm), in the pelvis anteroposterior diameter (121.26±7.01mm), export anteroposterior diameter (110.87±8.59mm), pubic symphysis height (32.45±2.95mm), sacrum length (108.33±9.50mm)12warp and pubic arch angle (88.52±8.46°), sacral (135.21±11.34°)2camber angle.
3, the modern Xinjiang Han women sacral morphological characteristics and physiological constant determination:100cases of the Han women sacral94patients were in line with the standard anatomical descriptions, no coccyx upturned. Were measured according to the sacrum typing the following sacral physiological constant: the length of the sacrum (four pairs of sacral foramina Standard:102.9±11.8mm;5sacral pass:125.8±13.2mm), sacral curvature (the sacral foramina standard type:134.8±14.6°; of5sacral pass:135.2±3.2°), the presacral hole and sacral hole diameter of longitudinal diameter, the hole iliac line spacing, the sacral hiatus width and depth (measuring the first, second and third, respectively, four sacral foramina, see text).
4, modern Xinjiang Han female pelvis type characteristics:in Xinjiang Han women in 100cases, the main female pelvis,65cases, accounting for65.0%; followed by great apes, in18cases, accounting for18.0%; the flat pelvis rare,13cases, accounting for13.0%; male pelvis is the most rare,4cases, accounting for4.0%.. The most common female and apes pelvis.
The Third Section:Discussion
1,Based on the early application of digital three-dimensional reconstruction and measurement techniques Xinjiang modern Uighur women pelvic reconstruction and measurement based on100cases,100cases Xinjiang Han women CT raw data, combined with medical interactive software Mimics, with Uighur women pelvic reconstructive same parameters, the successful reconstruction of the100cases of complete Xinjiang region the modern Uyghur Han female pelvis, strong sense of three-dimensional reconstruction of the pelvis and the anatomic landmarks clearly arbitrary angle rotation, scaling, segmentation and measurement.
2,Using Geomagic software can be arbitrary separation cutting rebuild part of the pelvis structure such as a left and the right side of the pelvis and sacrum. Mimics and UG software for three-dimensional measurements of the pelvis, a total of14obstetric physiological constant measurement.
3,Detailed comparison with Uighur female pelvic morphology, and obstetric physiological constant isolate rebuilt Han women sacrum, clear its morphological characteristics, and complete the Determination of Physiological constant of the sacrum. The reconstruction of100cases of female Han the sacrum seen coccyx upturned.
4, In pelvic morphology study found:of Xinjiang modern Han female pelvic morphology mainly female type and apes pelvis, followed by flat type, male-type lowest proportion.
Part four
The pelvic physiological constant comparison study between the Xinjiang Uighur female and Han female [Objective]
The female pelvis is one of the main factors affecting the delivery.The formation and development of the female pelvis is affected by various factors such as climate, nutrition, diet and crafts habits.Along with the economic, cultural and living standards improve, the female pelvis also change. However, our current obstetric traditional clinical remains pelvis data of more than20years ago, and no nation divided.Using digital three-dimensional reconstruction of digitized measurement technology to rebuild the pelvis obstetric physiological constants of various diameter line measured values, the Uighur and Han wome.in this research, in order to highlight the differences between the different ethnic groups, provide a reference for the development of the female pelvic parameters for the region in the development of obstetric diameter line standards.
The first section:materials and methods
1, the object of study
From2012January to2013January, in the people's Hospital of Xinjiang autonomous region, Hetian People's Hospital, Yili Xinhua hospital image center,thel00Han and100Uighur fertility active women,age25-40years old, Uighur group mean age (31.6±6.7) years old, Han group mean age (30.1±5.8) years old were selected.All women living in Xinjiang, the body upright, legs of normal development, and they have at least a full-term pregnancy, vaginal birth history, neonatal birth weight between2500g-4000g, eliminate pathological pelvis. Pelvic diameters is measured and the data was analyzed among the groups.
2. software and equipment:The same with part two and part three.
3.3D reconstruction and measurement method:The same with part two and part three.
4.statistical methods:
4.1The pelvic measurement data obtained from the comparison between the two groups, using the SPSS13.0statistical software for statistical observation index, calculated mean and standard deviation of each group. Among the groups in pelvic morphology,we used the chi-square test (Fisher 's Exact Test),,and independent samples T-test for comparing the pelvic physical constants. if P≤0.05was considered statistically significant difference between groups.
4.2Sacrum measurement data comparison between the two groups:Calculated mean and standard deviation of each group, Between the groups in pelvic morphology,we used the chi-square test (Fisher's Exact Test), and independent samples T-test was used for compare measurement data,if P<0.05was considered statistically significant difference between groups.
The second section:the results
1. Obstetric physiological constant mean diameter line comparison results among Xinjiang Uighur women and Han women.
1.1There is a significant difference among two groups:Two groups in the pelvic inlet plane diameters measured value differences were statistically significant (P<0.05), in the middle of sagittal diameter of the pelvic midplan and the exit plane sacrum camber difference was statistically significant (P<0.05), the rest of the diameter line difference was not statistically significant (P>0.05). The pelvic inlet diameter of Xinjiang Uygur female greater than Han women (P=0.000), but the anteroposterior diameter of the inlet, sagittal diameter of the entrance, the sacral shame diameter less than Han women (P=0.000). in the middle of sagittal diameter of the pelvic midplan of the Uighur female pelvis sagittal diameter of less than Han women (P=0.029) the sacral curvature less than Han women (P=0.024).
2. The sacrum digitized three-dimensional model of the physiological constant measurement results, morphology and comparison between Xinjiang Uighur and Han women
2.1Sacral morphology comparison between Xinjiang Uighur women and the Han women:94of100Han women sacral was accord with standard anatomical description,6cases of sacral5pass. But100cases of Uigur women in63cases (63%) as the standard type;7cases were non standard4pairs of sacral pass, including lumbar sacralization completely in2cases,3cases of lumbar sacral insufficiency, lumbarization in2cases;5of the sacral groove10cases (10%); sacrococcygeal joint abnormal type (including the tailbone upward or coccygeal sacralization type)20cases (20%). By chi-square test, there was significant difference between two minority female sacral morphological categories (x2=37.246, P=0.000).100cases of Uigur women have20people. The coccyx, and Han women were observed (Fig.11-14). There was a significant difference between the two (x,2=22.22, chi-square P=0.000).And compared with the measured results,2Uighur and Han women digital three-dimensional model of sacral physiological constant
2.2Sacrum digitized three-dimensional model of the physiological constant measurement results and comparison between Uighur and Han women:the transverse diameter of Xinjiang Uighur women and Han women around the sacral foramina longitudinal diameter hole iliac line spacing and width of the sacral hiatus difference was not statistically significant (P>0.05); sacrum before and after the hole is deep distance and sacral hiatus depth difference was statistically significant (P<0.05), Uighur women sacrum before and after hole contour interval and the sacral hiatus depth was significantly greater than the Han women. Xinjiang Uighur women and Han women Standard sacrum sacrum length and sacrum angle differences was not statistically significant (P>0.05). Non-standard sacrum fewer cases, basic Uighur women.
3. The proportion of the pelvic type among the Xinjiang Uighur women and Han women.
In100cases of Xinjiang Han women, female type was65cases, accounting for65%; flat type in13cases, accounting for13%; Simian type in18cases, accounting for18%;4cases were male type, accounting for4%. The most common type is female. In Xinjiang100Uighur women, female type was42cases, accounting for42%; flat type in38cases, accounting for38%; Simian type in15cases, accounting for15%;5cases were male type, accounting for5%. The female type and flat type were the most common. By chi-square test, there was a significant difference (χ2=17.583, P=0.000). Flat pelvis of the Xinjiang Uygur women significantly higher proportion of Han women, but the proportion of female pelvic significantly lower than Han women.
THE Third Section:Discussion
1.There are4of14physiological pelvic constants in Xinjiang Uighur women and Han women obvious difference, the4different constants are located at the entrance plane. Uighur women pelvic inlet diameter of greater than Han women around the inlet diameter, sagittal diameter of the entrance, sacral the shame inside diameter smaller than the Han women. The pelvis after middle sagittal diameter of the Uighur women smaller than the female Han, the sacral curvature less than the Han women
2.3D reconstruction and measurement differences in Xinjiang Uighur women and Han women sacrum morphological category. Which Uighur women coccyx upturned ratio is more common than Han women. Xinjiang Uighur women the hole
引文
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