股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义  

Anatomic study on the proximal femoral lateral wall and its clinical implications for geriatric intertrochanteric fractures

作　　者：张世民[1] 马卓[1] 杜守超[1] 胡孙君[1] 陶友伦[1] 

机构地区：[1]同济大学附属杨浦医院骨科,上海200090

出　　处：《中国临床解剖学杂志》2016年第1期39-42,共4页Chinese Journal of Clinical Anatomy

基　　金：上海市科委医学引导类基金资助(14411971900)

摘　　要：目的研究观测股骨近端外侧壁的骨性与软组织解剖特征,为临床向股骨头内打入拉力螺钉或螺旋刀片的股骨外侧皮质提供参考数据。方法采用16例成人股骨干燥标本、10例尸体下肢标本和20例老年股骨转子间骨折的横断面CT图像,分别测量外侧壁的骨性面积、软组织附着及其面积以及外侧壁骨皮质的厚度。结果骨性外侧壁平均高(24.4±2.4)mm,宽(23.3±2.0)mm,面积(567.0±82.8)mm2。臀中肌、臀小肌的止点与股外侧肌起点,在外侧壁处相互交织,形成致密坚韧的腱膜样重叠部,平均高(33.2±2.3)mm,宽(28.2±1.9)mm,厚(1.6±0.1)mm。老年人小转子平面的股骨外侧壁皮质薄弱,厚仅(2.3±0.5)mm。结论老年股骨转子间骨折的外侧壁皮质薄弱,容易骨折。推荐选用头髓钉系统进行内固定治疗,具有较高的安全性。Objective Proximal femoral lateral wall is defined as the lateral cortex distal to the vastus insertion, which is the entry point to put lag screw/helical blade into femoral head for fixation of intertrochanteric fractures. This study was focused on the bony and soft-tissue of lateral wall anatomy, and aimed to provide reference data for clinical implications. Method Sixteen femurs, 10 lower limbs and 20 CT slices in geriatric pertrochanteric fractures were used to measure the bony area （height and width）, softtissue attachment and intersection （height, width and thickness）, and femur lateral cortical thickness at the mid lesser trochanteric level. Result The bony lateral wall has a mean height of （24.4±2.4） mm, width of （23.3± 2.0） mm, and area of （567.0±82.8） mm^2. The attachments of gluteus medius and minus terminal and the vastus origin were mixed and intersected with each other to form a tedious aponeurotic structure together. The softtissue lateral wall has a height of （33.2±2.3） mm, width of （28.2±1.9） mm, and thickness of （1.6±0.1） mm. The femoral lareral wall in geriatric patients was very thin, with a cortical thickness of （2.3 ± 0.5） mm. Conclusion The lateral wall in geriatrics is very weak and vulnerable to fracture perioperatively. Cephalomedullary nail is superior to DHS for geriatric intertrochanteric fractures.

关 键 词：股骨近端外侧壁 外侧骨皮质 转子外侧壁 外侧壁软组织 转子间骨折 

分 类 号：R683.42[医药卫生—骨科学]