股骨颈骨折空间移位的三维重建研究  

Three-dimensional reconstruction study of the spatial displacement of femoral neck fractures

作　　者：姜轩[1] 马信龙[1] 马剑雄[1] 张弢[2] 王颖[1] 韩哲[1] 王辰[1] 张成宝[1] 孙磊[3] 

机构地区：[1]天津医院骨科研究所生物力学研究室,300211 [2] 天津医科大学总医院 [3] 天津市天津医院骨科研究所影像学与体内示踪研究室

出　　处：《中华骨科杂志》2015年第4期315-319,共5页Chinese Journal of Orthopaedics

基　　金：吴阶平基金会临床科研专项资助基金（320.6750.11017）

摘　　要：目的 通过三维重建研究并测量移位型股骨颈骨折中股骨头的空间移位,探讨股骨颈骨折严重程度及判断预后.方法 收集80例移位型股骨颈骨折患者（Garden分型Ⅲ型40例、Ⅳ型40例）双侧股骨近端多层螺旋CT扫描的薄层原始数据（DICOM格式）,导入三维重建软件生成双侧股骨近端三维模型.在健侧股骨近端生成患侧的镜像模型并与健侧相配准,使患侧镜像模型在健侧处形成新的蒙罩,在蒙罩上进行关键点标记,通过三维测量技术来计算股骨头空间移位参数,并对数据进行整理和分析.结果 GardenⅢ型骨折股骨头小凹最深点位移为（23.70± 10.00） mm,Ⅳ型（30.24±8.96） mm,两者比较差异有统计学意义;GardenⅢ型骨折中股骨头中心的位移为（14.36±5.61）mm,Ⅳ型为（18.77±5.45）mm,两者比较差异有统计学意义;GardenⅢ型骨折中股骨头空间偏转的角度为29.18°±15.74°,Ⅳ型为39.08°±17.08°,两者比较差异有统计学意义.移位型股骨颈骨折股骨头移位方向主要为后下方.结论 Garden分型对移位型骨折的认识存在一定局限性;三维重建及空间测量技术能更科学、准确地评价股骨颈骨折后股骨头移位的程度,为骨科医生评估骨折类型、严重程度及预后,制定更合理的手术方案提供更为宽广的临床思路.Objective To measure the displacement parameters of the femoral head of displaced femoral neck fracture in space through three dimensional reconstruction so as to provide new ideas in diagnosing,assessing and prognosing.Methods A review of 80 patients with an average age of 71.5 years old （range,39-80 years;36 males,44 females） who suffered displaced femoral neck fractures from June 2013 to June 2014 were included in our study.Bilateral proximal femurs of displaced femoral neck fractures contains 40 Garden type Ⅲ and 40 Garden type Ⅳ were scanned by spiral CT preoperatively.Through reconstructing these primitive CT data by the Mimics software,the affected leg mirror model generated and repositioned base on the normal femur,then a new mask was created on the registered mirror model in the CT cross-sectional images,marked key points in the masks and measured the displacement parameters of femoral head with three dimensional measurement tools automatically.Results In the displaced femoral neck fractures,the femoral head displacement angle was 29.18°±15.74° in Garden type Ⅲ and 39.08°± 17.08° in Garden type Ⅳ.The average displacement distance of femoral head center were 14.36±5.61 mm and 18.77±5.45 mm,respectively.The average displacement distance of the deepest point of fovea capitals of femoral head were 23.70± 10.00mm compare with 30.24±8.96 mm.Conclusion A high proportion of the displaced femoral neck fractures have a large of displacement in the three dimensional space.Currently Garden＆#39; s Classification exists certain limitation and incredibility in recognizing severity of the displaced femoral neck fractures.Three-dimensional reconstruction and spatial measurement technology can be more scientific and accurate in evaluating the degree of displacement of the femoral head.Our study could inspire and broaden clinicians＆#39; insights including diagnose fracture type,assess the degree of damage,establish a more rational and safe surgery plan and determine postoperative prognosis.

关 键 词：股骨颈骨折 成像 三维 摄影测量法 

分 类 号：R687[医药卫生—骨科学]