股骨颈骨折空间移位程度与内固定术后股骨头缺血性坏死的相关性研究  

Assodation between spatial displacements of femoral neck fracture and avascular necrosis of femoral head after internal fixation

作　　者：张成宝[1] 马信龙[1] 马剑雄[1] 王颖[1] 王辰[1] 姜轩[1] 王兴博[1] 孙磊[1] 卢斌[1] 刘彦士 

机构地区：[1]天津医院骨科研究所,生物力学研究室,300211

出　　处：《中华创伤骨科杂志》2016年第2期133-137,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨基于三维重建的股骨颈骨折空间移位程度与内固定术后股骨头缺血性坏死的相关性。方法回顾性分析2010年1月至2013年1月收治的163例股骨颈骨折患者资料，男61例，女102例；平均年龄为55．7岁。骨折Garden分型：I型20例，Ⅱ型30例，Ⅲ型57例，Ⅳ型56例.收集所有患者术前及术后股骨近端多层螺旋CT扫描的薄层原始数据，通过Mimics10．01软件测量所有患者术前、术后股骨头空间移位参数（小凹最低点移位、中心移位、空间移位角度）。所有患者根据术后是否发生股骨头缺血性坏死分为2组：坏死组与非坏死组，比较两组患者的一般资料及术前、术后股骨头空间移位参数。应用多因素logistic回归分析探究股骨头缺血性坏死的相关因素。结果163例患者术后获2．5-5．4年（平均3．1年）随访。其中33例（20．2％）患者发生股骨头缺血性坏死d坏死组与非坏死组患者术前骨折Garden分型，术前股骨头小凹最低点移位、中心移位、空间移位角度，术后股骨头小凹最低点移位、中心移位、空间移位角度比较差异均有统计学意义（P〈0．05）。多因素logistics回归分析结果显示：术前股骨头空间移位参数、术前骨折Garden分型及术后股骨头空间移位参数与股骨头缺血性坏死相关（P〈0．05）。结论基于三维重建的股骨颈骨折空间移位程度能准确评估术前移位程度及复位质量，术前骨折移位程度、骨折类型及术后骨折复位质量是决定是否发生股骨头缺血性坏死的主要因素。Objective To explore the association between the spatial displacements in the three-dimensional reconstruction of femoral neck fracture and avaseular necrosis of femoral head after internal fixation. Methods One hundred and sixty-three patients with femoral neck fracture were included in this study who had been treated at our institute between January 2010 and January 2013. They were 61 males and 102 females, with an average age of 55.7 years. By Garden classification, 20 cases were type Ⅰ, 30 type Ⅱ, 57 type Ⅲ and 56 type Ⅳ. All their preoperative and postoperative primitive CT data were imported to Mimics 10. 01 software for three-dimensional reconstruction of femoral neck fractures in which the spatial displacement parameters （the lowest displacement at the dimple, central displacement, and spatial displacement angle） were measured. The patients were divided into 2 groups according to presence,or absence of postoperative avascular necrosis of femoral head. The 2 groups were compared in terms of demographic data, preoperative and postoperative spatial displacement parameters. Multivariate logistic regression analysis was performed to explore the risk factors of avascular necrosis of femoral head. Results The average duration of follow-up was 3. 1 years （range, from 2. 5 to 5. 4 years）. Avascular necrosis of femoral head was found in 33 cases （20. 2% ）. There were significant differences between the necrosis and necrosis-free groups in preoperative Garden classifications, all the preoperative and postoperative spatial displacement parameters （the lowest displacement at the dimple, central displacement, and spatial displacement angle） （ P 〈 0. 05）. Multivariate logistic regression analysis showed that preoperative spatial displacement parametem of the femoral head,preoperative Garden classification of the fracture, and postoperative spatial displacement parameters of the femoral head were associated with avascular necrosis of femoral head （ P 〈 0. 05） . Conclusions Three-dimens

关 键 词：股骨颈骨折 成像 三维 摄影测量法 股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学]