移位型股骨颈骨折空间移位三维重建及其临床意义  

Three-dimensional analysis of displaced femoral neck fracture and its clinical significance

作　　者：付鑫[1] 韩哲[1] 马信龙[1] 张弢[2] 徐桂军[1] 王树俊[1] 徐康[1] 卢晋[1] 姜轩[2] 

机构地区：[1]天津医院创伤骨科,300211 [2]天津医科大学总医院骨科

出　　处：《中华创伤杂志》2015年第1期37-41,共5页Chinese Journal of Trauma

基　　金：吴阶平医学基金会临床科研专项基金资助项目（320.6750.11017）;天津市卫生局科研基金攻关资助项目（11KG137）

摘　　要：目的 测量移位型股骨颈骨折股骨头的空间移位程度并进行三维重建,为临床评估移位型股骨颈骨折严重程度及判断预后提供依据. 方法 收集80例移位型股骨颈骨折患者（GardenⅢ型40例,GardenⅣ型40例）双侧股骨近端多层螺旋CT薄层扫描数据（DICOM格式）,导入三维重建软件生成双侧股骨近端三维模型.通过软件的三维测量技术计算股骨头空间移位参数,并进行数据整理和分析. 结果 GardenⅢ型、Ⅳ型股骨头小凹最深点的移位分别为（23.7±10.0）mm和（30.2±9.0） mm（P＜ 0.05）;GardenⅢ型、Ⅳ型股骨头中心的移位分别为（14.4 ±5.6）mm和（18.8 ±5.5）mm（P ＜0.05）;GardenⅢ型、Ⅳ型股骨头空间位移的角度分别为（29.2±15.7）.和（39.1±17.1）.（P＜0.05）.GardenⅣ型组中13％ （5/40）为粉碎性骨折,而GardenⅢ型组无粉碎性骨折. 结论 三维重建能更全面、准确地评价股骨颈骨折类型及移位程度.目前使用较为广泛的Garden分型对于移位型股骨颈骨折的认识存在一定局限性,临床医师需重新认识并制订更适宜的诊疗方案.Objective To measure the displacement of the femoral head via three-dimensional reconstruction so as to re-understand the displaced femoral neck fracture.Methods Eighty patients with displaced femoral neck fracture were included in the study including 40 with Garden type Ⅲ and 40 with Garden type Ⅳ fractures.Spiral CT of bilateral proximal femurs was performed along with threedimensional reconstruction.Displacement parameters of femoral head were determined with threedimensional measurement technology.Results In cases of Garden type Ⅲ and Ⅳ fractures,displacement of the deepest point of fovea capitis of the femoral head was （23.7 ± 10.0） mm and （30.2 ± 9.0）mm（P 〈 0.05） ; displacement of femoral head center was （14.4 ± 5.6）mm and （18.8 ± 5.5） mm （P 〈 0.05） ; femoral head displacement angle was （29.2 ± 15.7）°; and （39.1 ± 17.1） ＆#176; （P 〈 0.05）.The incidence of the comminuted fracture was 13% （5/40） among the patients with Garden type Ⅳ fracture.In comparison,no comminuted fracture occurred among the cases of Garden type Ⅲ fracture.Conclusions Three-dimensional reconstruction and digital measurement are precise and efficient methods for the measurement of fracture type and displacement in patients with femoral neck fracture.The present Garden classification for femoral neck fracture has certain defects and limitations.The clinicians should re-understand the displaced femoral neck fracture and choose more reasonable treatment.

关 键 词：股骨颈骨折 成像 三维 移位 

分 类 号：R687.3[医药卫生—骨科学]