骨质疏松性股骨颈骨折近端形态特点及其临床意义  

Morphological characteristics and its clinical significance of proximal end of osteoporotic femoral neck fractures

作　　者：杜心如[1] 续开亮[1] 要星晨 张雪华 DU Xin-ru;XU Kai-liang;YAO Xing-chen;ZHANG Xue-hua(Department of Orthopedics,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;不详)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]北京市第一中西医结合医院,北京100020

出　　处：《中国骨与关节损伤杂志》2022年第6期571-575,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨骨质疏松性股骨颈骨折近端的形态特点.分析股骨颈的结构性薄弱区,为进一步研究其发生机制提供客观依据。方法纳入自2008-07-2020-12行人工股骨头置换术治疗的83例骨质疏松性股骨颈骨折,获得股骨颈骨折近端标本83个,观察骨折发生部位,骨折线走行特点并进行解剖分类。对75个标本进行X线片Pauwels分型并测量Pauwels角,并与术前X线片Pauwels分型结果比较。结果骨质疏松性股骨颈骨折最常见的类型是头颈型骨折,头颈型骨折标本54个(典型头颈型41个,非典型头颈型13个),头下型骨折标本13个,特殊型骨折标本15个,1个标本不能分型,无经颈型骨折。75个标本正位X线片的Pauwels分型:Ⅱ型12例,Ⅲ型63例;而术前正位X线片上Pauwels分型:Ⅱ型20例,Ⅲ型55例,差异无统计学意义(P>0.05)。术前正位X线片上Pauwels角为(55.95±10.24)°,标本正位X线片上Pauwels角为(66.13±14.32)°,差异有统计学意义(P<0.001)。头下型股骨颈骨折多数为Pauwels Ⅱ型,头颈型、特殊型股骨颈骨折多数为Pauwels Ⅲ型。结论骨质疏松性股骨颈骨折几乎为头颈型和头下型.骨折线自头颈交界处上外后方向前下方走行至股骨颈中部。股骨头颈交界处上外侧区域骨皮质薄弱,主压力骨小梁集中并与股骨颈内下骨皮质融合,这是骨质疏松性股骨颈骨折断端部位。在术前X线片上进行骨质疏松性股骨颈骨折Pauwels分型较为准确,但是对骨折断端具体角度的判断仍存在一定差异。Objective To explore the morphological characteristics of the proximal end of osteoporotic femoral neck fractures and analyze the structural weakness of the femoral neck,so as to provide an objective basis for further research on its pathological mechanism.Methods A total of 83 osteoporotic femoral neck fractures treated with artificial femoral head replacement from July 2008 to December 2020 were included and 83 proximal specimens of femoral neck fractures were obtained.The fracture sites,the characteristics of the fracture line and anatomical classification were observed.The Pauwels classification of X-ray films and the measurement of Pauwels angle were performed on 75 specimens,and the results were compared with those of preoperative X-ray Pauwels classification.Results The most common type of osteoporotic femoral neck fractures was head-neck fractures.There were 54 head-neck fracture specimens(41 typical head-neck fractures and 13 atypical head-neck fractures),13 sub-head fractures and 15 special type fractures.One specimen could not be classified,and there was no neck fractures in this group.Pauwels classification of 75 specimens on anteroposterior X-ray films showed:12 cases of type Ⅱ and 63 cases of type Ⅲ;while Pauwels classification on preoperative anteroposterior X-ray films showed:20 cases of type Ⅱ and 55 cases of type Ⅲ;There was no significant difference(P>0.05).The Pauwels’angle was(55.95±10.24)°on preoperative X-ray film and(66.13±14.32)°on specimen X-ray film,with significant difference(P<0.001).Most of the sub-head fractures were Pauwels type Ⅱ,while those of head-neck fracture and special fracture were Pauwels type Ⅲ.Conclusion The osteoporotic femoral neck fractures are almost of head-neck type and subhead type,and the fracture line running from the superior-anterior at the junction of head and neck to the middle of the femoral neck.The bone cortex in the superior and lateral area at the junction of femoral head and neck is weak,and the main pressure bone trabeculae is centra

关 键 词：骨质疏松性股骨颈骨折 股骨颈骨折近端标本 股骨头 股骨头颈交界处 Pauwels分型 

分 类 号：R683.4[医药卫生—骨科学]