股骨颈嵌插型骨折空间移位程度的三维重建研究  

reconstruction study of the displacement of impacted femoral neck fractures

作　　者：杜长岭[1] 马信龙[1,2] 张弢[1] 马剑雄[1] 孙晓雷[2] 付鑫[2] 张清[2] 功卢晋[2] 

机构地区：[1]天津医科大学总医院骨科, 300052 [2]天津医院

出　　处：《中华骨科杂志》2012年第5期451-456,共6页Chinese Journal of Orthopaedics

基　　金：吴阶平医学基金会临床科研专项资助基金（320.6750.11017）

摘　　要：目的测量股骨颈嵌插型骨折股骨头的空间移位参数，以重新认识股骨颈嵌插型骨折。方法收集50例股骨颈嵌插型骨折患者双侧股骨近端的多层螺旋CT扫描的薄层原始数据，男17例，女33例。将原始数据（DICOM格式）导入三维重建软件生成双侧股骨近端三维模型。在健侧生成骨折侧的镜像模型并将其与健侧相配准，使配准后的骨折侧镜像模型在CT横截面图像上生成新的蒙罩，在蒙罩上进行关键点的标记，通过软件三维测量技术计算股骨头空间移位参数，并分析测量数据。结果嵌插型骨折股骨头空间移位角度为17．17°±10．40°，70％（35／50）的患者股骨头空间移位角度分布于10°-35°之间，30％（15／50）的患者股骨头空间移位〉20°；股骨头中心的移位距离为（6．49±3．60）mm，股骨头小凹最深点的移位距离为（10．42±5．92）mm。部分股骨颈嵌插型骨折存在很大的空间移位及成角，将其完全归类于GardenI型骨折存在一定的偏差。结论三维重建数字化测量技术能够更加准确、高效地测量股骨颈骨折的真实空间移位程度。经典的股骨颈骨折Garden分型对于嵌插型骨折的认识存在一定的局限性；临床医生需重新认识嵌插型骨折，从而制定更适宜的诊疗方案。Objective To measure the displacement parameters of the femoral head in space through CT three-dimensional reconstruction so as to re-understand impacted femoral neck fractures. Meth. ods Fifty patients with impacted femoral neck fractures were included in the study. There were 17 males and 33 females. Bilateral proximal femurs of each patient were scanned by spiral CT preoperatively. Then these primitive CT data were reconstructed by Mimics 10.01 software. Registered the normal femur and fracture mirror model, the registered mirror model was generated a new mask in the CT cross-sectional images, marked key points in the masks and measured the displacement parameters of femoral head with threedimensional measurement technology. Results In the impacted femoral neck fractures, the femoral head displacement angle was 17.17°±10.40°, 70% （35/50） of the patients had femoral head rotation angle was at 10° to 35°, and 30%（15/50） of the patients had femoral head space displacement more than 20°. The average displacement distance of femoral head center and the deepest point of fovea capitis were （6.49±3.60） mm and （10.42±5.92） mm, respectively. A high proportion of the impacted femoral neck fractures had a large of displacement in the three-dimensional space. It is not scientific to equal impacted femoral neck fractures to undisplaced fractures. Conclusion Three-dimensional reconstruction and digital measurement is a precise, efficient and convenient method for the measurement of femoral head displacement parameters in femoral neck fracture patients, The classic Garden classification for impacted femoral neck fractures has certain defects and limitations. Clinicians should re-understand impacted femoral neck fractures and choose more reasonable treatment.

关 键 词：股骨颈骨折 成像 三维 分类法 

分 类 号：R687.3[医药卫生—骨科学]