股骨颈骨折术前空间移位三维重建研究及其临床意义  

Preoperative three-dimensional reconstruction for displacement assessment of femoral neck fracture and its clinical significance

作　　者：张成宝[1,2] 马信龙[1,2] 马剑雄[2] 王颖[2] 王辰[2] 姜轩[2] 孙磊[2] 王兴博[2] 社长龄 卢斌[2] 刘彦士 

机构地区：[1]天津医科大学总医院骨科,300070 [2]天津医院骨科研究所生物力学研究室

出　　处：《中华创伤杂志》2016年第3期203-206,共4页Chinese Journal of Trauma

基　　金：基金项目：吴阶平基金会临床科研专项资助基金（320.6750.11017）

摘　　要：目的通过三维重建测量股骨颈骨折空间移位，重新认识Garden分型并为不同类型骨折严重程度及预后判断提供依据。方法收集2012年5月-2014年8月150例股骨颈骨折患者，其中GardenI型23例，Ⅱ型30例，Ⅲ型42例，Ⅳ型55例。术前行双侧股骨近端螺旋CT扫描，通过Mimics10．01阈值选定、区域增长、镜像配准等功能生成股骨近端三维模型，测量不同类型骨折股骨头空间移位参数并进行统计学分析。结果6例不完全性GardenI型股骨颈骨折中经三维重建发现3例为完全骨折、3例为不完全骨折，GardenI型嵌插性骨折空间移位角度为（19．8±12．5）°。GardenⅡ型、GardenⅢ型、GardenⅣ型骨折股骨头中心移位分别为（7．0±2．5）mm、（14．1±6．8）mm、（20．4±9．3）rnm；股骨头小凹最低点移位分别为（11．6±4．4）mm、（23．2±11．2）mm、（30．1±10．1）mm；空间移位角度分别为（22．1±9．9）°、（31．5±15．2）°、（37．8±13．5）°。除GardenⅡ型骨折与嵌插性骨折空间移位参数差异无统计学意义（P〉0．05），其余各类型骨折空间移位参数差异均有统计学意义（P〈0．05）。结论经典Garden分型有一定的局限性，骨科医师需要重新认识并制订适宜的治疗方案；三维重建能更准确地评价骨折类型及骨折空间移位参数，值得临床推广及应用。Objective To measure the displacement in femoral neck fracture by three-dimensional reconstruction, reconsider the classic Garden classification and provide guidance to evaluate the severity of different types of fracture and prognosis. Methods One hundred and fifty patients with femoral neck fracture admitted between May 2012 and August 2014 were included including 23 Garden type I fracture, 30 type Ⅱ fracture, 42 type Ⅲ fracture and 55 type Ⅳ fracture. Bilateral proximal femurs in all were scanned by spiral CT preoperatively. Mimics 10.01 software was used to develop the three-dimensional model by thresholding, region growing and mirror matching. Displacement of the femoral head was measured with the three-dimensional design. Results Among the six patients with incomplete Garden type I fracture, three were verified as incomplete fracture and three complete fracture using the three- dimensional measurement technology. Femoral head displacement angle was （ 19.8 ± 12.5 ） ° in impactedfemoral neck fracture. In the patients with type Ⅱ , Ⅲ and IV fractures, the medial displacement of the femoral head was （7.0 ±2.5 ） mm, （ 14.1± 6.8） mm and （20.4± 9.3 ） ram, the deepest point of fovea capitiswas （11. 6 ±4.4）mm, （23. 2 ± 11. 2） mm and （30. 1 ± 10. 1）mm; the femoral head displacementangle was （22.1 ±9.9）°, （31.5 ± 15.2）° and （37.8 ± 13. 5）°. Differences in dimensional displacement parameters among all types fractures were statistically significant except the comparison between type Ⅱ fracture and impacted fracture （P 〈 0.05 ）. Conelusions Classic Garden classifica- tion has some limitations, thus clinicians should reunderstand the femoral neck fracture and formulate more reasonable treatment protocols. Three-dimensional reconstruction provides accurate evaluation of fracture type and displacement parameters and has high clinical value.

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]