| Objective:Reconstruct the the femoral head three-dimensional CT in the diagnosis and analysis system based on three-dimensional CT image data, the three-dimensional femoral head necrosis model, visualize determine the site of the necrosis, measured the volume of necrotic lesions and osteonecrosis of the femoral head specimens volume comparison explore its accuracy and practical clinical efficacyMethods:38patients (53hips) with ONFH (26male,12females), the patients had the mean age of38.5years (range32-58years old). The pathogenesis were hormonal of17cases(28hips), alcohol of14cases(17hips), idiopathic necrosis of4cases (4hips), trauma of3(4hips). ARCOⅡ11hips;Ⅲ30hips;Ⅳ12hips.all patients every six months to conduct a three-dimensional CT scan again before the three-dimensional CT scan row full hip replacement surgery, hip three-dimensional CT images in DICOM data. developed its own sharesthe osteonecrosis measurement software image import, extract the outline of the femoral head and the necrotic area and directly read the volume of the region of the femoral head and the necrotic tissue and the percentage difference between the percentage of necrosis accounting for each quadrant. clinical follow-up tofemoral head collapse as the end of the observation, not collapse the patients observed for at least24months. Use SPSS17.0statistical software reconstruction of the femoral head and the real femoral head necrosis volume differences t test, to choose linear correlation and regression analysis, correlation analysis of various parameters and collapse.General measure of total hip replacement surgery, after surgery to remove the femoral head, Shift Water Act measured roughly the femoral head and the necrotic lesion volume, compared with the computer results were statistically analyzed.Result:The three-dimensional model of the reconstruction of the femoral head avascular necrosis of the femoral head located outside the top, in line with the general position of the femoral head necrosis lesions.42hips software measured the volume of the entire femoral head was48.03±4.82cm3(range36.42～61.38cm3), the necrotic lesion volume was20.63±6.54cm3(range was10.52to38.94cm3). Femoral head necrosis lesion volume ratio of the volume of the entire femoral head for42.6%±11.78,roughly measured by the average volume of the entire femoral head (4866±4.42) cm3, the average volume of the femoral head necrosis area (20.7±5.5) cm3(range of10～39cm3). Femoral head necrosis volume ratio of the volume of the region of the femoral head as a whole was42.5%±11.87.Physical measurement volume value is slightly larger than the volume of software measurement values slightly, comparing the two is about1.23%of the volume of the entire femoral head, femoral head necrosis regional volume of about1.97%larger. Both measuring the volume of the femoral head is0.43±0.7cm3, there was no statistically significant difference (paired t=-1.515,P>0.05); femoral head necrosis lesion volume difference of0.97±0.45cm3no statistically significant difference (paired t=-1.523, P>0.05).Clinical follow-up38patients (53hips) collapse occurred in34hips, the average femoral head necrosis volume ratio of35.8%±12.5, not the collapse of the11hips, the average femoral head necrosis volume ratio of16.35%±5.42; In collapsed femoral heads, the distribution of necrosis site was as following:10.3%±7.9in t1,11.3%±6.8in t2,6.3%±7.9in t3,22.3%±8.7in t4,23.5%±11.7in t5,12.3%±8.1in t6,3.6%±2.6in t7,4.1%±5.3in t8,2.7%±6.9in t9,1.1%±2.4in t10,1.3%±3.3in t11,1.1%±1.6in t12;While those in femoral heads without collapse were as following:27.3%±10.8in t1,23.5%±11.7in t2,13.6%±7.9in t3,11.3%±6.9in t4,12.3.%±7.8in t5,6.3%±7.9in t6,3.6%±2.6in t7,4.1%±5.3in t8, i2.7%±6.9in t9,0.1%±2..4in t10,0.3%±3.3in t11,0.1%±1.6in t12.Correlation and regression analysis showed that the femoral head necrosis volume ratio (vol) and the the collapse closely related (p<0.05), necrosis t4, t5and t6quadrant distribution proportion of femoral head collapse is closely related (p<0.05). When necrotic lesions greater than35%by volume, the collapse of the femoral head necrosis rate of more than76%.Conclusion:Three-dimensional reconstruction under CT scan can demonstrate the morphology of ONFH accurately and reliably, which will help surgeon better understand the morphology and orientation in femoral head. The volume and distribution of necrotic site in ONFH is correlative to the collapse of femoral head. Regression analysis showed that necrotic volume ratio of greater than35%, i.e. there is a risk of collapse of the femoral head necrosis volume ratio plays an important role in predicting the femoral head collapse in. In the distribution of femoral head necrosis necrosis of the small-scale play an important role in predicting collapse potential dangers when necrosis volume ratio of less than20%necrosis distribution in the first t4-t6quadrant (femoral head outside the top), there is risk of... |
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