股骨近端解剖形态的CT三维重建与分析

目的:通过CT三维重建正常中国人股骨近端大体形态,测量29个解剖参数,为选择、设计假体提供解剖学依据.方法:对82例正常中国人进行双侧股骨近端CT扫描,在CT三维重建后利用医学图像分析软件对股骨近端的解剖形态进行参数测量,并与现有资料进行比较.结果:股骨近端髓腔的形状和大小有明显的个体差异性,股骨近端各形态参数接近正态分布,左右无明显差异;颈干角与偏心距之间呈现很强的负相关,股骨头直径与股骨颈直径、股骨头高度、股骨头顶点至大转子间的距离、股骨前弓最高点至小转子上缘截面距离有较强的相关性;与白种人相比较,在偏心距、颈干角上有显著性差异(P＜0.01),中国人的偏心距较白种人明显小,而颈干角明显大于白种人;与现有国内利用X线片测量的参数相比,各参数无明显统计学差异.结论:选用欧美人工髋关节假体,需考虑中国人股骨近端解剖形态与白种人之间的差异,以便术中恢复股骨头中心;股骨CT三维重建对定制性假体的意义重大,而股骨X线片对标准型假体的选择,具有方便、实用的优点.

CT 3D reconstruction and analysis of proximal femur anatomical morphology

Objective:To obtain 29 anatomic parameters of normal Chinese proximal femur through CT 3D reconstruction so as to provide anatomical references for hip prosthesis selection and design. Methods:Bilateral proximal femurs of 82 normal Chinese were scanned by CT and visualized by CT 3D reconstruction. The parameters of proximal femur were measured by medical imaging analysis software and compared with the existing references. Results: The shape and size of proximal femoral medullary cavity had obvious individual diversities. All morphologic parameters of the proximal femur was close to a normal distribution with no marked difference between left and right side. Neck shaft angle was negatively correlated with offset; the femoral head diameter had a strong correlation with femoral neck diameter, femoral head height, distance between femoral head tip to great trochanter, and distance between apex of femur anterior arch to less trochanter section. The offset and neck-shaft angle were significantly different between Chinese and Caucasian(P<0.01),with the Chinese offset being shorter and neck-shaft angle being larger. There was no significant difference in all parameters between the existing domestic parameters by X ray measurement and those obtained in this study. Conclusion:It is important to consider the differences in proximal femoral anatomical morphology between Chinese and Caucasian when selecting hip prosthesis for restoring the center of femoral head during total hip replacement. Femur CT 3D reconstruction is important for customizing hip prothesis and femur X ray is convenient and practical in selecting standard hip prosthesis.