基于X线片测量的股骨头中心和股骨颈轴线的偏距
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摘要
目的通过对正常髋关节X线片的测量以研究股骨头中心和股骨颈轴线的偏距,有助于了解股骨头、颈的形态学特征,为股骨头、颈损伤后的治疗与康复,施行髋关节表面置换术等提供参考数据,也可以为人类研究积累资料。
方法应用X线摄片系统采集99名健康大学生右髋关节正侧位平片,其中有12人因摄片模糊不清或者异物遮挡无法准确测量予以放弃,剩余87例计174张;分别应用游标卡尺和软件测量股骨头中心和股骨颈轴线的偏距以及股骨头半径,求出每组数据的平均值和标准差。
结果测量结果记录时,正位片上以头心在颈轴的外上方为正,内下方为负;侧位片上以头心在颈轴的后侧为正,前侧为负(见附录二);分析结果采用平均值加减标准差方式表示。利用游标卡尺手工测量值:正位片偏距为1.30±2.12mm,侧位片偏距1.11±2.34mm,正位片头半径为26.20±2.16mm,侧位片头半径为26.02±2.16mm,正侧位头半径差0.18±0.23mm。利用Photoshop7.0软件中绘图测量功能测量值:正位片偏距为1.30±2.09mm,侧位片偏距为1.12±2.35mm,正位片头半径为26.18±2.13mm,侧位片头半径为26.00±2.16mm,正侧位头半径差为0.19±0.18mm。同时应用SPSS12.0 for Windows软件对结果进行方差齐性检验以及方差分析,方差均齐,且两种测量方法无显著差异。
讨论通过对测量结果分析可以看到,头心颈轴偏距个体差异较大,股骨头的左右径与前后径相比略大。本研究通过对X线片上股骨头心与股骨颈轴线偏距的测量,发现股骨头颈形态的复杂性,尽管对此进行了有益的探索,但如何更合理的对此进行描述需要有大量的相应参数,如何更合理地设计研究方法,更准确的进行测量,更有效的利用该指标指导临床工作等仍需进一步研究。
Objective By measuring the The offset of the femoral head and the axis of femur by X-ray,it is able to achieve the morphology character morphology the head and the axis of femur,to provide data for hip surface replacement,and for the treatment and habilitation after femoral head and neck of femur injury.It also can accumulate data for human study.
Method accumulate the anterior-posterior and lateral hip X-ray of 99 healthy undergraudates. Twelve were exclusive because they can not be measured accuretely for unclearness or other objection dodge.Eighty-seven cases(174 hips) remained.Measure the offset of the femoral head and the axis of femoral neck and the radius of femoral head with vernier caliper and software respectively,then calculate the mean and standard deviation of each group.
Result In anteroposterior radiography,the head center sitting at the out and upward of the axis of femur neck is recorded positive,at in and downward is recorded negtive.In lateral radiography,the head centre sitting at the posterior of the axis of femur neck is recorded positive,at anterior is recorded negtive.Results is expressed by M±SD.For vernier caliper measurements,the offset in anterioposterior radiography is 1.30±2.12mm, in lateral radiography is 1.11±2.34mm,the radius of femoral head in anterioposterior radiography is 26.20±2.16mm,in lateral radiography is 26.02±2.16mm,the differernce of radius of femur head between anterioposterior radiography and lateral radiography is 0.18±0.23 mm;By Photoshop7.0,the offset in anterioposterior radiography is 0.18±0.23 mm,in lateral radiography is 1.12±2.35mm,the radius of femur head in anterioposterior radiography is 26.18±2.13mm,in lateral radiography is 26.00±2.16mm,the difference of radius of femur head between anterioposterior radiography and lateral radiography is 0.19±0.18mm。when the homogeneity test for variance and ANOVA is tested by SPSS-12.0 for Windows,the variance is equal and there is no signaficant difference between the two measument by SPSS12.0 for Windows.homogeneity test for variance and ANOVA,variance homoscedasticity,the two measurements have no significant deviation. Discussion The offset of the femoral head and the axis of femoral neck is of larger individual variation.The left-right radius is larger than the anterior-posterior radius.By the measurement of the offset of the centre of the femur head and the axis of the femoral neck,it can be found that the morphological of head and thc neck of the femur is of large complexity.Although explorasion is done,more data is needed for how to describe it more reasonable.Further study is needed to find how to design study methods better,how to measure more accurately,and how to guide clinical work more effectively using this index.
方法应用X线摄片系统采集99名健康大学生右髋关节正侧位平片,其中有12人因摄片模糊不清或者异物遮挡无法准确测量予以放弃,剩余87例计174张;分别应用游标卡尺和软件测量股骨头中心和股骨颈轴线的偏距以及股骨头半径,求出每组数据的平均值和标准差。
结果测量结果记录时,正位片上以头心在颈轴的外上方为正,内下方为负;侧位片上以头心在颈轴的后侧为正,前侧为负(见附录二);分析结果采用平均值加减标准差方式表示。利用游标卡尺手工测量值:正位片偏距为1.30±2.12mm,侧位片偏距1.11±2.34mm,正位片头半径为26.20±2.16mm,侧位片头半径为26.02±2.16mm,正侧位头半径差0.18±0.23mm。利用Photoshop7.0软件中绘图测量功能测量值:正位片偏距为1.30±2.09mm,侧位片偏距为1.12±2.35mm,正位片头半径为26.18±2.13mm,侧位片头半径为26.00±2.16mm,正侧位头半径差为0.19±0.18mm。同时应用SPSS12.0 for Windows软件对结果进行方差齐性检验以及方差分析,方差均齐,且两种测量方法无显著差异。
讨论通过对测量结果分析可以看到,头心颈轴偏距个体差异较大,股骨头的左右径与前后径相比略大。本研究通过对X线片上股骨头心与股骨颈轴线偏距的测量,发现股骨头颈形态的复杂性,尽管对此进行了有益的探索,但如何更合理的对此进行描述需要有大量的相应参数,如何更合理地设计研究方法,更准确的进行测量,更有效的利用该指标指导临床工作等仍需进一步研究。
Objective By measuring the The offset of the femoral head and the axis of femur by X-ray,it is able to achieve the morphology character morphology the head and the axis of femur,to provide data for hip surface replacement,and for the treatment and habilitation after femoral head and neck of femur injury.It also can accumulate data for human study.
Method accumulate the anterior-posterior and lateral hip X-ray of 99 healthy undergraudates. Twelve were exclusive because they can not be measured accuretely for unclearness or other objection dodge.Eighty-seven cases(174 hips) remained.Measure the offset of the femoral head and the axis of femoral neck and the radius of femoral head with vernier caliper and software respectively,then calculate the mean and standard deviation of each group.
Result In anteroposterior radiography,the head center sitting at the out and upward of the axis of femur neck is recorded positive,at in and downward is recorded negtive.In lateral radiography,the head centre sitting at the posterior of the axis of femur neck is recorded positive,at anterior is recorded negtive.Results is expressed by M±SD.For vernier caliper measurements,the offset in anterioposterior radiography is 1.30±2.12mm, in lateral radiography is 1.11±2.34mm,the radius of femoral head in anterioposterior radiography is 26.20±2.16mm,in lateral radiography is 26.02±2.16mm,the differernce of radius of femur head between anterioposterior radiography and lateral radiography is 0.18±0.23 mm;By Photoshop7.0,the offset in anterioposterior radiography is 0.18±0.23 mm,in lateral radiography is 1.12±2.35mm,the radius of femur head in anterioposterior radiography is 26.18±2.13mm,in lateral radiography is 26.00±2.16mm,the difference of radius of femur head between anterioposterior radiography and lateral radiography is 0.19±0.18mm。when the homogeneity test for variance and ANOVA is tested by SPSS-12.0 for Windows,the variance is equal and there is no signaficant difference between the two measument by SPSS12.0 for Windows.homogeneity test for variance and ANOVA,variance homoscedasticity,the two measurements have no significant deviation. Discussion The offset of the femoral head and the axis of femoral neck is of larger individual variation.The left-right radius is larger than the anterior-posterior radius.By the measurement of the offset of the centre of the femur head and the axis of the femoral neck,it can be found that the morphological of head and thc neck of the femur is of large complexity.Although explorasion is done,more data is needed for how to describe it more reasonable.Further study is needed to find how to design study methods better,how to measure more accurately,and how to guide clinical work more effectively using this index.
引文
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8.Nelson CL,Walz BH,Gruenwald JM.Resurfacing of only the femoral head.Jarthroplasty,1997,12:736-740.
9.Ogata K,et al.A Simple Biplanar Method of Measuring Femoral Anteversion and Neck-Shaft Angle.J Bone Joint Surg(AM),1979;61:846
10.姚振强 王成焘.一种利用CT片族确定股骨头空间几何中心位置的方法.医用生物力学,1996,11(4):216-218.
11.Rubin PJ,et al:The morphology of the proximal femur-a three dimensional radiographic analysis.) Bone Joint Surg 74-B:28,1992.
12.Hoaglund FT et al:Anatomy of the femoral neck and head,with comparative data from Caucasians and hong kong Chinese.Clin Arthop 152:10,1980.
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24.Amstutz HC,Kabo M,Hermens K,Dorey F,Kilgus D.Porous surface replacement of the hip with chamfer cylinder design.Clin Orthop,1987;222:140.
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31.Nork SE,Schar M,Plander G,et al.Anatomic considerations for the choice of surgical approach for hip resurfacing arthroplasty.Orthop Clin North Am,2005,36(2):163-170.
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2.Mills H.J et al:The relationship between proximal femoral anatomy and ostoarthrosis of the hip.Clin Arthop 288:205,1993
3.Wroblewski B.M et al二The calcar femorale in cemented stem fixation in total hip arthroplasty.J Bone Joint Surg 82-B:6,2000
4.龙公等,股骨上端形态曲线的测量、参数化与统计分析。医用生物力学,13卷:100,1997
5.汤宇,等.股骨偏心距与全髋关节置换术后假体功能及相关生物力学的变化.中国临床康复,2006,10(33):133-135.
6.Amstutz HC,Beaule PE,Dorey FJ,et al.Metal-on-metal hybrid surface arthroplasty:two to six-year follow-up study.J Bone Joint Surg Am,2004,86-A(1):28-39.
7.Amstutz HC,Grigoris P,Safran MR,et al.Precision-fit surface hemiarthroplasty for formal head osteonecrosis.J Bone Joint Surg,1994,76-B(3):423-427
8.Nelson CL,Walz BH,Gruenwald JM.Resurfacing of only the femoral head.Jarthroplasty,1997,12:736-740.
9.Ogata K,et al.A Simple Biplanar Method of Measuring Femoral Anteversion and Neck-Shaft Angle.J Bone Joint Surg(AM),1979;61:846
10.姚振强 王成焘.一种利用CT片族确定股骨头空间几何中心位置的方法.医用生物力学,1996,11(4):216-218.
11.Rubin PJ,et al:The morphology of the proximal femur-a three dimensional radiographic analysis.) Bone Joint Surg 74-B:28,1992.
12.Hoaglund FT et al:Anatomy of the femoral neck and head,with comparative data from Caucasians and hong kong Chinese.Clin Arthop 152:10,1980.
13.Smith-Petersen MN.The classic:Evolution of mould arthroplasty of the hip joint.J Bone Joint Surg Br,1948,30B:15,59-75.
14.Aufranc OE.Constructive hip surgery with VITALLIUM mould.J Bone and Joint,1957;39 A:237.
15.Akeson WH,Miyashita C,Taylor TKF,Laviolette D,Amiel D.Experimental arthroplasty of the canine hip:Extracellular Matrix composition in cup arthroplasty.J Bone Joint Surg,1969;51A:149.
16.Charnley J.C.Arthroplasty of the hip:A new operation.Lancet,1961;1:1129.
17.Haboush EJ.A new operation for arthroplasty of the hip based on biomechanics photoelasticity fast setting dental acrylic and other considerations.Bull.Hosp.Jt.Dis.Orthop Inst,1953,13:242
18.Townley CO.Intramedullary cup-stem arthroplasty for the hip joint.A 16mm film.Chicago.AOS,Audio-Visual Film Library,1964.
19.Muller ME,Boltzy X.Artifcal hip joints made from PROTOSOL.Bull.Assoc.Study problems internal fisation,1986,pp1-5.
20.Gerard Y.Hip arthroplasty by matching cups.Clin Orthop 1978;134:25-35.
21.Freeman MAR.Some anatomical and mechanical considerations relevant to the surface replacement of the femoral head.Clin Orthop,1978;134:19-24.
22.Amstutz HC,Grigoris P,Dorey FJ.Evolution and future of surface replacement of the hip.J Orthop Sci,1998,3(3):169-186.
23.Amstutz HC,Clarke IC,Christie J.Total hip articular replacement by internal eccentric shells.Clin Orthop,1977;128:261.
24.Amstutz HC,Kabo M,Hermens K,Dorey F,Kilgus D.Porous surface replacement of the hip with chamfer cylinder design.Clin Orthop,1987;222:140.
25.徐卫东,李甲.髋关节表面置换的历史发展及经验.中国矫形外科杂志,2005,15(17):1322-1324.
26.Howie DW,Cornish BL,Vemon-RobertsB.The Viability of the femoral head after resurfacing hip arthroplasty in humans[J].Clin Orthop,1993,291:171-184.
27.Campbell P,Mirra J,AmstutzHE.Viability of femoral heads treated withmsurfacing arthroplasty[J].J Arthroplasty,2000,15(1):120-122.
28.Amstutz HC,Beaule PE,Dorey FJ,et al.Metal-on-metal hybrid surface arthroplasty:two to six-year follow-up study.J Bone Joint Surg Am,2004,86-A(1):28-39.
29.王琦,曾炳芳,髋关节表面置换术.国外医学骨科学分册,2005:26:58-59.
30.范永前,冯建民,杨庆铭,髓关节表面置换术进展.国际骨科学杂志.2007,28(4):224-227.
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