股骨近端相关影像解剖学测量研究

doi:10.13418/j.issn.1001-165x.201

摘要/Abstract

摘要：

目的　目的通过CT三维重建测量正常国人老年股骨近端的相关形态参数，为设计股骨近端内固定系统提供解剖学依据。方法对60位老年国人的股骨近端进行CT扫描，利用自带的医学图像处理软件进行三维重建，标定相关解剖标志，测量指标包括股骨小转子、股骨颈干角、股骨头偏心距以及股骨髓腔等相关解剖参数。结果所有测量参数左、右侧均无统计学差异（P＞0.05），其中小转子纵径为(26.80±2.53) mm，横径为(16.09±1.72) mm，小转子高度为(8.41±1.50) mm，小转子体积为(727.15±165.18)mm3，拟固定小转子最短螺钉长度为(46.77±2.70) mm，应用上倾角为（16.83±2.06）°，股骨颈干角为（131.42±8.03）°，股骨头偏心距为（37.85±7.02） mm。结论 CT三维重建图像可精确识别股骨相应的解剖标志并进行解剖学测量，测量数据对老年转子间骨折的治疗和新型解剖锁定钢板的设计有参考价值。

关键词: 股骨近端, 小转子, 三维重建, 老年

Abstract:

Objective To obtain the morphological parameters of the proximal segment of the femur in Chinese healthy senior population through three-dimensional reconstruction of CT images of the femur in order to provide the anatomical basis for the design of the proximal femoral internal fixation system. Method The CT scan data of the proximal segment of the femur of 60 Chinese healthy senior personswas obtained and the three-dimensional reconstruction of the femur was performed using the system’s default software. The bony landmarks were determined on the three-dimensional images of the normal femur. Measurement included the anatomic indexes of the lesser trochanter, neck shaft, angle, femoral offset and femoral canal, etc. Results There was no statistically significant difference of all measurement parameters between the left side and the right side (P>0.05), and length of the vertical axis of the lesser trochanter was (26.80±2.53) mm and its the transverse diameter was(16.09±1.72) mm; The height and the volume of the lesser trochanter was (8.41±1.50) mm and (727.15±165.18) mm3, respectively. The minimum length of the screw used to fix the lesser trochanter of the femur was (46.77±2.70) mm, and the up-dip angle was (16.83±2.06)°, the neck-shaft angle was（131.42±8.03）°, the range of femoral offset was（37.85±7.02）mm. Conclusion It is feasible to accurately identify the anatomical landmarks on the three-dimensional reconstruction of the femur. The measurement data was beneficial to treatment of the elderly patients with intertrochanteric fractures and design of the proximal femoral internal fixation system for fixation of the lesser trochanter

Key words: Proximal femur, The lesser trochanter, Three-dimensional reconstruction, Elderly

中图分类号:

R323.72

吴炳华, 尹生江, 戴闽, 徐聪. 股骨近端相关影像解剖学测量研究[J]. 中国临床解剖学杂志, 2015, 33(1): 28-32.

TUN Bing-Hua, YIN Sheng-Jiang, DAI Min, XU Cong. The research of relevant image anatomy measurements of the proximal segment of femur [J]. Chinese Journal Of Clinical Anatomy, 2015, 33(1): 28-32.

参考文献

[1] 张海波, 李华强, 贾思明. 股骨转子间骨折内固定方法选择及应用技巧
[J]. 中国矫形外科杂志, 2003, 11(14):999-1000.

[2] 王亚梓, 王蕾, 张海生. 股骨转子间粉碎骨折小转子必须固定吗
[J]. 中华创伤骨科杂志, 2004, 6(9):970-971.

[3] 孔繁杰, 闵多, 覃奇文. 采用国产股骨近端髓内钉治疗老年股骨转子间骨折
[J]. 中国矫形外科杂志, 2005, 13(10):738-740.

[4] 安永胜, 李桂萍, 杜心如, 等. 经股骨外侧皮质固定小转子解剖学的初步测量及临床意义
[J]. 中国矫形外科杂志, 2009, 17(8):611-613.

[5] 张亮, 周一新, 柳剑. 强直性脊柱炎股骨近端前倾角和颈干角测量结果
[J]. 中国骨与关节外科, 2012, 5(3):193-197.

[6] 杜心如, 卢世璧. 股骨上段髓腔径线研究及其临床意义
[J]. 中国临床解剖学杂志, 2006, 24(4):359-363.

[7] 王兆杰, 安荣泽, 齐新文, 等. 小转子复位固定在股骨转子间骨折治疗中的临床意义
[J]. 中国矫形外科杂志, 2009, 17(4):312-313.

[8] 何小文, 吴子征, 张键. 股骨转子间骨折重建股骨距的临床解剖学研究
[J]. 中国临床解剖学杂志, 2012, 19(4):383-385.

[9] Baumgaertner MR, CurtinSL, Lindskog DM. The value of the tip-apex distance in predicting failure of fixation of peretrochanteric fractures of the hip
[J]. J Bone Joint Surg Br, 1995, 77(7): 1058-1064.

[10]刘磊, 周建伟, 王以进, 等. 股骨近端骨折内固定头颈钉不同位置置放的生物力学研究
[J]. 中国矫形外科杂志, 2010, 18(4):300-303.

[11]Bourne BR, Rorabeck CH. Soft tissue balancing: The hip
[J]. J Arthroplasty, 2002, 17 (4 Suppl 1):17-22.

[12]Ferris BD, Kennedy C, Bhamra M, et al. Morphology of the femur in proximal femoral fractures
[J].JBJS, 1989,71(3): 475-477.

[13]Laine HJ, Puolakka TJ, Moilanen T, et al. The effects of cement less femoral stem shape and proximal surface texture on “fit-and-fill” characteristics and on bone remodeling
[J]. Int Orthop, 2000, 24 (4):184-190.

[14]Callaghan JJ, Albright JC. Charnley total hip arthroplasty with cement: minimum twenty-five-year follow-up[J].JBJS, 2000, 82(4): 487-491.
[15]殷浩, 黄彰, 江华, 等. 股骨偏心距的测量及其临床意义[J].中国临床解剖学杂志, 2010, 28(1):10-13.
[16]Noble PC, Alexander JW, LindahlLJ, et al. The anatomic basis of femoral component design[J].Clin Orthop Relat Res, 1988, (235):148-165.
[17]汪伟, 王岩, 崔健. 正常股骨近端CT测量及其临床意义[J]. 中国临床解剖学杂志, 2003, 21(2):125-128.
[18]]Massln P, Geais L, Astoin E, et a1. The anatomic basis for the concept of lateralized femoral stems-Afrontal planera diographic study of the proximal femur[J]. Arthroplasty, 2000, 15(1):93-101.
[19]赵洪普, 徐秋玉, 曾勉东，等. 老年股骨转子间骨折股骨近端锁定板与动力髋螺钉内固定治疗比较[J]. 中国矫形外科杂志, 2011, 10（19）:793-796.
[20]Saini P, Kumar R, Shekhawat V, et al. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate[J].Injury, 2013, 44(2):226-231.
[21]孙欣, 曾荣, 陈俊虎, 等. 股骨转子间骨折三种内固定治疗方法疗效比较[J].中国矫形外科杂志, 2012, 20(10):884-886.
[22]王黎明, 邱冠军, 张伟东, 等. 三种手术方法治疗老年股骨转子间骨折的比较研究[J].中国矫形外科杂志, 2011, 19(14):1179-1181.
[23]梁成军, 武文杰. 四种手术方式治疗转子间骨折的临床应用研究[J].吉林医学, 2011, 32(5):924-925.