股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究  

Differences in femoral neck shaft angles between anteroposterior X-ray and 3-dimensional CT reconstruction images:report of 265 cases

作　　者：刘力铭 雷凯 范华全 陈欣 杨柳 郭林 LIU Liming;LEI Kai;FAN Huaquan;CHEN Xin;YANG Liu;GUO Lin(Center of Joint Surgery,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院关节外科中心,重庆400038

出　　处：《第三军医大学学报》2020年第21期2134-2140,共7页Journal of Third Military Medical University

摘　　要：目的探讨股骨颈干角在前后位X线平片与CT三维重建图像上的差异及其主要相关因素。方法通过陆军军医大学第一附属医院电子病历系统回顾性收集2016年8月至2018年6月于关节外科中心住院患者资料265例(265侧下肢)。判定其股骨颈干角在前后位X线平片与CT三维重建图像上的差异性。通过记录其年龄、性别、BMI、左右侧别,测量其髋膝踝角、股骨干弓形角、股骨扭转角、股骨远端机械轴外侧角、股骨干长度,并建立统计学模型,筛选导致其差异的最主要因素。同时设立对照组及试验组,通过1∶1倾向性评分匹配验证导致差异的最主要相关因素。结果股骨颈干角X线平片测量值(128.02±6.26)°与其CT三维图像测量值(124.22±6.45)°具有统计学差异(P<0.001),且差异大于3°的占比高达56.6%。多重线性回归模型(P<0.001,调整R2=0.747)显示股骨扭转角(标化系数=-0.233,P<0.001)是其差异的最主要相关因素。结论股骨颈干角在前后位X线平片与CT三维重建图像上存在显著差异,股骨扭转角是导致差异的主要相关因素,较大的股骨颈外旋扭转会伴有股骨颈干角的X线测量结果偏大。Objective To explore the differences in measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image,and investigate the main related factors that lead to the differences.Methods The clinical data of 265 lower limbs from 265 patients hospitalized in our center from August 2016 to June 2018 were retrospectively collected from the electronic medical record system of our hospital.The femoral neck shaft angle was measured on the anteroposterior X-ray films and 3-dimensional CT reconstruction images,and the difference was tested.Age,gender,BMI,left and right difference,hip-knee-ankle angle,femoral bowing angle,femoral torsion angle,mechanical lateral distal femoral angle and femoral shaft length were included to establish a statistical model to screen the most important factors leading to the difference.Finally,a control group and an experimental group were set up through the 1∶1 propensity score matching to verify the the most important factors.Results The femoral neck shaft angle was(128.02±6.26)°on the anteroposterior X-ray films and(124.22±6.45)°on the 3-dimensional CT reconstruction images,and statistical difference was found between them(P<0.001),with a difference greater than 3°(accounting for 56.6%of the patients).The established multiple linear regression model(P<0.001,adjusted R^2=0.747)showed that femoral torsion angle(standardized regression coefficient=-0.233,P<0.001)was the most important factor of the difference.Conclusion There is a difference in the measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image.Femoral torsion angle is the most important factor.Larger femoral extorsion angle causes larger femoral neck shaft angle measured on the anteroposterior X-ray film.

关 键 词：股骨颈干角 股骨扭转角 三维重建图像 X线平片 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学] R681.8[医药卫生—基础医学]