三维手段定量评估股骨颈骨折复位质量与股骨头坏死的相关性  

Correlation between reduction quality of femoral neck fracture and femoral head necrosis evaluated by three-dimensional measurement method

作　　者：张立朋[1] 张国玲[2] 徐葳[1] 王丹[1] 王文良[2] 

机构地区：[1]武警后勤学院病原生物学与免疫学教研室,天津市300000 [2]武警后勤学院附属医院关节三科,天津市300000

出　　处：《中国组织工程研究》2016年第22期3287-3293,共7页Chinese Journal of Tissue Engineering Research

基　　金：天津市科技支撑重点项目(13ZCZDSY01700)~~

摘　　要：背景:骨折复位质量对骨折愈合与肢体功能恢复至关重要,传统X射线片与断层CT对量化与直观观察骨折移位效果不佳。Mimics具有快速构建骨骼模型和空间测量的功能,为定量三维空间量化复位质量提供了可能。目的:利用三维测量方法对X射线评估为复位满意的股骨颈骨折患者进行残留移位再测量,并探究残留移位与股骨头坏死的相关性。方法:将2012年1月至2013年12月于武警后勤学院附属医院关节三科接受治疗的141例股骨颈骨折患者纳入研究,按骨折移位程度分组,无移位组44例(Garden1&2),移位组97例(Garden3&4)。利用CT的DICOM数据建立每个患者的三维模型,测量修复术后股骨颈骨折患者的残留移位参数:股骨头中心距离、股骨头小凹距离及空间偏转距离。对患者股骨头坏死情况进行随访,探究残留移位程度与股骨头坏死的相关性。结果与结论:1患者随访时间为25-43个月,无移位组和移位组中分别有7例和21例患者罹患股骨头坏死;2无移位组中股骨头中心距离、股骨头小凹距离、空间偏转角度分别为(7.44±2.84)mm,(11.75±4.12)mm,(17.68±8.99)°;移位组分别为(6.51±3.75)mm,(9.34±5.27)mm,(14.67±7.43)°,两组中除股骨头中心距离外差异均有显著性意义(P<0.05);3提示复位质量欠佳是引起股骨头坏死的重要因素之一;同时X射线在描述空间立体移位和角度中存在不足,在评估股骨颈骨折的复位质量时具有局限性;而利用三维测量手段评估骨折复位质量具有一定的优越性。BACKGROUND：Reduction quality is essential for the healing and function of limb.Traditional X-ray and CT scans have some limitations in quantitatively and visually observing the reduction quality of the remnant fracture in three-dimensional displacements.Mimics have advantages in bone rapid modeling and three-dimensional measurement,which offers the chance in quantifying the reduction quality of the displacement in three-dimensional methods.OBJECTIVE：To measure residual displacement in femoral neck fracture patients with satisfactory reduction by using three-dimensional measurement method,and to evaluate the association between residual displacement and femoral head necrosis.METHODS：We enrolled 141 patients with femoral neck fracture,who were treated in the Third Department of Joint,Affiliated Hospital of Logistics University of People＇s Armed Police Force from January 2012 to December 2013.All patients were divided into undisplaced fracture group（n=44;Garden12） and displaced fracture group（n=97;Garden34）.Based on DICOM data of CT files,three-dimensional models were constructed in each patient.Three parameters were measured：displacement of femoral head＇s center,fossa capitis femoris and rotational displacement.Femoral head necrosis was followed up.The correlation between residual displacement and femoral head necrosis was explored.RESULTS AND CONCLUSION：（1） The duration of follow-up in those patients ranged from 25 to 43 months.Femoral head necrosis occurred in 7 cases from the undisplaced fracture group and 21 cases from the displaced fracture group.（2） The three parameters（displacement of femoral head＇s center,fossa capitis femoris and rotational displacement） were respectively（7.44±2.84） mm,（11.75±4.12） mm and（17.68±8.99）° in the undisplaced group,and（6.51±3.75） mm,（9.34±5.27） mm and（14.67±7.43）° in the displaced group.Except displacement of femoral head＇s center,significant differences in the other two parameters were detected between the tw

关 键 词：股骨骨折 股骨头坏死 内固定器 随访研究 组织工程 骨科植入物 骨植入物 股骨颈骨折 复位质量 三维测量 

分 类 号：R318[医药卫生—生物医学工程]