贵州地区正常股骨髓腔 X 线片影像解剖学研究

Anatomical study of the normal femoral medullary cavity based on X-ray image in Guizhou Population

目的 通过测量贵州地区正常成人股骨髓腔X线片影像学数据,为股骨近端疾病诊疗、假体设计和选择提供参考。方法 搜集2015年1月1日至2016年12月31日,所有在我院放射科行股骨近端正侧位X线片检查的患者,符合筛选标准的共308例。通过医学影像软件SIEMENS Syngo. Plaza PACS对图像处理,测量股骨近端解剖参数值,并依据股骨髓腔开大指数(canal flare index,CFI)对测量的髓腔进行Noble分型,根据正侧位X线片髓腔特征进行Dorr分型。将测量结果根据性别、左右侧、年龄段进行分组,同国内外学者测量结果进行统计学分析。结果 贵州地区成人T0+20径线值为(4.44±0.53) cm,T0径线值为(2.63±0.41) cm,T0-20径线值为(1.89±0.31) cm,峡部内径为(1.14±0.21) cm,峡部外径为(2.84±0.30) cm,峡部位置为(10.6±1.32),股骨髓腔开大指数为(4.00±0.80),干骺端髓腔开大指数为(2.38±0.39),远端髓腔开大指数为(1.69±0.30)。按Noble分型,本组人群股骨近端髓腔烟囱型为12.3%,正常型为69.8%,香槟酒杯型为17.9%。按Dorr分型,本组人群股骨近端髓腔Type A型30.5%,Type B型49.7%,Type C型19.8%。各项参数在左右侧别比较差异无统计学意义,其中T0+20、T0、T0-20、峡部内径、峡部外径、峡部位置、干骺端髓腔开大指数(metaphyseal canal flare index,MCFI)、股骨远端髓腔开大指数(distal canal flare index,DCFI)在男女性别之间差异有统计学意义,其中男性测量均值大于女性。T0、T0-20、峡部内径、峡部位置在年龄组之间差异有统计学意义。同国内学者研究比较,部分参数有差异。但同欧美等国外学者研究比较,本研究多项参数值明显偏小。结论 贵州地区股骨近端X线测量的解剖参数与国人其它地区存在差异,与欧美人比较则有明显不同,有必要建立贵州地区股骨近端解剖参数数据库,为选择和设计符合贵州地区人群的股骨柄假体提供参考。

Objective To measure proximal femoral parameters of the adult in Guizhou area by X-ray film to provide references for the diagnosis and treatment of proximal femoral diseases,design and choosing of the artificial joint.Methods A total of 308 cases who met the inclusion criteria were selected.AP and lateral images of the upper femur were collected from January 1,2015 to December 31,2016.Main parameters of the proximal femur were measured by SIEMENS Syngo.Plaza PACS.The medullary cavity was classified according to the canal flare index (CFI).Dorr classification was carried out according to the characteristics of the medullary cavity by anterior and lateral X-rays.The measurement results were grouped according to gender,left or right side and age.Statistical analysis on the measurement results from domestic and foreign scholars was carried out.Results The Guizhou adult T0 +20 was (4.44±0.53) cm,T0 (2.63±0.41) cm,T0-20 (1.89±0.31) cm,isthmus intramedullary diameter(1.14±0.21) cm,isthmus extramedullary diameter (2.84±0.30) cm,isthmus position (10.6±1.32),CFI(4.00±0.80),MCFI (2.38±0.39) and DCFI (1.69±0.30).Noble type:stove-pipe 12.3%,normal 69.8%,champagne-fluted 17.9%.Dorr type:Type A 30.5%,type B 49.7%,type C 19.8%.The parameters were not statistically significant between left the and right side.Statistical significance was observed in T0 +20,T0,T0-20,isthmus intramedullary diameter,isthmus extramedullary diameter,isthmus position,MCFI (2.38±0.39),DCFI (1.69±0.30)and gender (higher in males).Statistical significance was noted in T0,T0-20,isthmus intramedullary diameter and isthmus position in different age groups.Compared with the study of foreign scholars in Europe and the United States,several parameters in the Guizhou area were significantly smaller.Conclusions The anatomical parameters of the proximal femur in Guizhou province measured by X-ray are different from those in other regions of China,especially in Europe and America.Therefore,it is necessary to establish a database of anatomical parameters of the proximal femur in Guizhou,so as to provide references for the selection and design of femoral stem prosthesis that suits the population in Guizhou.