近端股骨量測比較方法學之研究

Abstract

主題一：股骨前傾角的量測：三維電腦斷層掃描下三種方法的比較 過去的文獻中有許多量測股骨前傾角的方法。三維的電腦斷層掃描曾經在許多的研究中使用，在這個主題中，我們利用三維電腦斷層掃描模擬並評估三種傳統的量測股骨前傾角之方法。共有18隻家犬，包括8隻黃金獵犬與10隻拉不拉多犬接受檢查，這些犬隻在檢查前都已經接受臨床與放射線學的檢查以確定其沒有任何的骨科學疾病。取得電腦斷層掃描影像以後，利用軟體重組後分別進行模擬的解剖法、單向ｘ光法與雙向ｘ光法的檢查。總共有三十六個股骨接受檢查，模擬解剖法、單向ｘ光法與雙向ｘ光法所得之平均前傾角分別為24.00°±4.03°, 36.37°±5.23° 與 32.52°±3.34°。在這三種方法中，觀察者間與觀察者內的誤差均不具顯著差異。然而，以不同方法的量測所得的結果，卻具有顯著差異。本研究顯示利用三維電腦斷層掃描量測股骨前傾角應是可行的，但是利用不同方法所定義的不同解剖軸線，將有可能會獲得顯著不同的結果，因此，建議研究者應該要小心解讀不同方法所得的結果。 主題二：股骨頸幹角的量測：四種anterior-postriorｘ光照射下的量測方法之應用 因與許多髖關節疾病之預後有關，股骨頸幹角在臨床上顯得相當重要，在人的頸幹角測量中，最常使用的方法是以主觀的直接目測法取得股骨頸與股骨幹的軸線，本研究的目的是評估四種獸醫的量測頸幹角之方法在人類股骨之應用，並且與直接目測法比較。共有15位志願者接受檢查。所有的志願者都在臨床上與放射線學下不具有任何的關節疾病，將股骨以15°內轉以後照射Anterior-Posterior的ｘ光片，利用所提出之四種方法計算股骨的頸幹角並且與直接目測法互相比較。結果發現，而這五種方法的觀察者內之可靠度均佳。本研究中所提出的方法，在人醫臨床上均可以使用，但是，每個方法都有其不同的特色與缺點，在量測時，必須要根據病患不同的疾病去選擇方法。

Topic 1: Measurement of canine femoral neck anteversion: a comparison of 3 methods under three-dimensional computed tomography Various methods measuring canine femoral neck anteversion have been proposed in literatures. In this article, 3 conventional methods under computed tomography simulation were evaluated. 18 client-owned dogs, including 8 Golden retrievers and 10 Labrador retrievers clinically and radiologically free of orthopedic diseases were examined. 16-slices computed tomographic images were obtained from all dogs and analyzed on a desktop computer. Simulated anatomic, axial radiographic, and biplanar radiographic methods were used for the measurement of femoral anteversion. A total of 36 femurs were examined, the average femoral anteversion obtained by simulated anatomic, axial radiography and biplanar radiography methods were 24.00°±4.03°, 36.37°±5.23° and 32.52°±3.34°, respectively. No significant difference was detected within and between observers in each method. However, significant differences among different methods were found (p<0.05). The study suggested that the measurement of femoral neck anteversion using any of the conventional methods under three-dimensional computed tomography simulation is feasible in the dog. However, results from different methods must be interpretated cautiously. Topic 2: The comparative study of 4 veterinary methods in the measurement of human femoral inclination Femoral inclination is clinically important for its relationship to the prognosis of various hip joint diseases. In the measurement of human inclination angle, subjective visual recognition of femoral neck and shaft axis was regularly used. The purpose of this study is to evaluate 4 methods developed in veterinary medicine in the measurement of human femoral inclination and to compare them with the conventional direct visual method. 15 volunteers were examined in this study. The subjects were all clinically and radiologically free of orthopedic diseases. Anterior-posterior radiographs were taken with the femur under 15° internal rotations. Femoral inclination was calculated using direct visual measurement and the result was compared with 4 techniques modified from veterinary studies. Intra-observer reliability was good in all 5 methods. The results of this study showned that the methods proposed in veterinary studies may be used in human clinical settings. However; each method has its inherited features and disadvantages, the selection of method still depends on the nature of patient conditions.