股骨颈置钉通道安全靶区的模型骨CT研究及稳定空间坐标系的建立  

CT study on safety target area of femoral neck model screw channel and establishment of a stable spatial coordinate system

作　　者：邓迎生 杨洪平[2] 蒋广亮 Deng Yingsheng;Yang Hongping;Jiang Guangliang(Department of Orthopaedic,Affiliated Haikou Hospital of Xiangya Medical College,Central South University,Haikou 570208,China;Department of Orthopaedic,Tianyou Hospital Affiliated to Wuhan University of Science&Technology,Wuhan 430064,China;Department of Orthopaedic,Haikou Orthopedic and Diabetes Hospital,Haikou 570300,China)

机构地区：[1]中南大学湘雅医学院附属海口医院(海口市人民医院)骨科中心,海口570208 [2]武汉科技大学附属天佑医院骨科,武汉430064 [3]海口市骨科与糖尿病医院骨科,海口570300

出　　处：《中华骨科杂志》2023年第21期1441-1449,共9页Chinese Journal of Orthopaedics

基　　金：海南省自然科学基金面上项目(821MS160);海南省卫生健康行业科研项目(20A200517,22A200136)。

摘　　要：目的通过定向定量CT分析Sawbone股骨颈置钉通道横断面安全靶区的图像特征,并建立稳定空间直角坐标系。方法对40个Sawbone股骨模型行CT扫描及三维重建,将垂直于股骨颈外科中轴线的切面CT原位叠加获得交集,即为股骨颈横断面安全靶区。以股骨颈基底前皮质为参照基准,建立三维笛卡尔坐标系(x,y,z),测量安全靶区的上下径、前后径和倾斜角。将交集叠加至原横断面CT以确定安全靶区边界的冠状面位置;通过图像原位叠加法获得冠状面CT并集(相当于髋部正位X线片)和矢状面CT并集(相当于髋部侧位X线片),确定安全靶区的上下径、前后径透视边界峡部的冠状面位置(位于股骨颈的头下部或颈中部或基底部),比较CT安全靶区的边界位置与透视边界峡部位置的重合度。计算Pearson相关系数分析上下径与前后径的相关性。结果股骨颈横断面安全靶区呈倾斜的圆角四边形,其前底边平坦,与股骨颈基底部前皮质重合。安全靶区左、右侧的上下径分别为(35.13±0.51)、(30.98±0.82)mm,前后径分别为(26.66±0.39)、(27.53±0.72)mm,上下径与前后径无相关性(左侧:R=0.43,P=0.060;右侧:R=0.32,P=0.176)。所有透视边界峡部与相应的横断面安全靶区边界匹配,上下径透视边界峡部与横断面安全靶区的上下边界均位于颈中区,前后径透视边界峡部与横断面安全靶区的前后边界均位于基底部,斜倾角8°~29°。所有参数均在正常股骨颈范围内(股骨颈基底部前皮质平坦,上下径26~38 mm,前后径17~29 mm,倾斜角5°~53°)。结论交集法可便捷地获得定向定量的Sawbone股骨颈轴位安全靶区,基于股骨颈基底部前皮质可建立稳定空间直角坐标系。Objective To study the image features in direction and quantity on CT scans of the axial safety target area of Sawbone femoral neck screw tunnels and possibility of establishing a stable spatial cartesian coordinate system.Methods After three-dimensional reconstruction of CT data of 40 Sawbone femoral necks,the real axial CT images(perpendicular to the surgical central axis)of each femoral neck were superimposed respectively to get the intersection,called axial safe target area(ASTA).With the anterior cortex of femoral neck basilar seen as a landmark,the spatial rectangular coordinate system(x,y,z)was established to measure superior-inferior diameters(D-SI),anterior-posterior diameters(D-AP)and the oblique angles.Each intersection was overlapped to the original axial CT images to find coronal position of ASTA boundaries.In addition,coronal CT union(equivalent to anteroposterior X-ray)and sagittal CT union(equivalent to lateral X-ray)were obtained by images in situ superposition method,from which the coronal positions of the isthmus of the perspective boundary(D-SI and D-AP)were determined.The coincidence of the boundary positions of ASTA and those of the perspective isthmus was compared.Pearson correlation coefficients were calculated for the left and right sides respectively to analyze the correlation between D-SI and D-AP.Results Every ASTA presented an oblique rounded quadrilateral,whose front base was flat and coincided with anterior cortex of femoral neck basilar(FNB).In this coordinate system,D-SI were 35.13±0.51 mm on the left and 30.98±0.82 mm on the right,while D-AP were 26.66±0.39 mm on the left and 27.53±0.72 mm on the right.There was no significant correlation between D-SI and D-AP(left:R=0.43,P=0.060,right:R=0.32,P=0.176,respectively).All the isthmus of X-ray boundary fell at the corresponding ASTA boundary.The oblique angles ranged from 8°to 29°,and all parameters were within the range of normal femoral neck(the anterior cortex of the femoral neck basilar is flat,with a D-SI range of 26-38 mm,

关 键 词：股骨颈 骨螺丝 体层摄影术 螺旋计算机 安全靶区 

分 类 号：R68[医药卫生—骨科学]