髂嵴和股骨大转子相对解剖位置特点对髓内钉置入的影响  

Effects of relative anatomical position characteristics between the iliac crest and femoral greater trochanter on intramedullary nail placement

作　　者：李静[1,2] 平瑞月[3] 张国旭 谢骐骏 王中豪 王海洲 陈海云[3] 祁冀[1,3,4] Li Jing;Ping Ruiyue;Zhang Guoxu;Xie Qijun;Wang Zhonghao;Wang Haizhou;Chen Haiyun;Qi Ji(The Second Clinical School of Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong Province,China;Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,Guangdong Province,China;Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100020,China)

机构地区：[1]广州中医药大学第二临床医学院,广东省广州市510006 [2]广州中医药大学,广东省广州市5104052 [3]广东省中医院,广东省广州市510120 [4]中国中医科学院望京医院,北京市100020

出　　处：《中国组织工程研究》2023年第31期4949-4953,共5页Chinese Journal of Tissue Engineering Research

基　　金：广东省基础与应用基础研究基金区域联合基金项目(20201910240000337),项目负责人:祁冀;中国博士后科学基金面上项目(2021M690757),项目负责人:祁冀。

摘　　要：背景:股骨近端抗旋髓内钉在临床上被广泛用于治疗股骨转子间骨折,准确的置钉角度和位置可有效提高手术成功率,降低内固定相关并发症发生率。目的:基于放射学测量,分析髂嵴和股骨大转子之间相对解剖位置对髓内钉置入的可能影响。方法:收集广东省中医院骨科门诊87名正常成人标准骨盆正位片,其中男50名,女37名,年龄(43.72±14.45)岁,共174个髋关节,测量双侧髂嵴连线(La)和双侧股骨大转子连线(Lb)距离,髂嵴和大转子连线与骨盆中轴线的夹角(∠1),股骨解剖轴与骨盆中轴线的夹角(∠2)和颈干角(∠3)。在骨盆正位片上经髂嵴外侧缘做骨盆水平线的垂线,根据股骨大转子在垂线内外区分股骨大转子的显露程度,在线外为Ⅰ组(52个髋关节,显露程度大),在线内为Ⅱ组(122个髋关节,显露程度小);髂嵴遮挡角度Δ1=|∠1-∠2|,再根据股骨近端抗旋髓内钉具有5°外偏角分组,Δ1≤5°为Ⅱa组(66个髋关节),Δ1>5°为Ⅱb组(56个髋关节)。结果与结论:①Ⅰ组的La、La/Lb、Δ1值均小于Ⅱ组(P<0.05),Ⅱa组的La/Lb值大于Ⅱb组(P<0.05),Ⅰ组的Δ1值大于Ⅱa组(P<0.05)、小于Ⅱb组(P<0.05),Ⅱb组的Lb值小于Ⅰ组(P<0.05)、大于Ⅱa组(P<0.05);②结果显示,骨盆宽度相对于双侧股骨大转子之间的距离越小,遮挡程度越小,越易进钉;髂嵴遮挡程度越小,越利于进钉;有相当一部分人群存在髂嵴遮挡情况,如果术前发现髂嵴遮挡明显,术中摆体位时在维持解剖复位的前提下可以考虑适当增大内收程度,便于进钉,这对于临床操作具有指导意义。BACKGROUND:Proximal femoral nail anti-rotation is widely used in the treatment of femoral intertrochanteric fractures.Accurate screw placement angle and position can effectively improve the success rate of surgery and reduce the incidence of internal fixation-related complications.OBJECTIVE:To investigate the relative anatomical positional relationship between the iliac crest and the greater trochanter of femur on intramedullary nail placement based on radiological measurements.METHODS:174 hip joints were examined in 87 normal adult pelvic anteroposte rior radiographs in Orthopedic Clinic of Guangdong Provincial Hospital of Chinese Medicine.There were 50 males and 37 females at the age of(43.72±14.45) years.The distance between bilateral iliac crest line(La) and bilateral femoral trochanter line(Lb) was measured.The angle with the median pelvic axis(∠1),the angle between the anatomical axis of the femur and the median axis of the pelvis(∠2),and the neck-shaft angle(∠3) were measured.On the pelvic anteroposte rior radiograph,the vertical line of the horizontal line of the pelvis was made through the lateral margin of the iliac crest.The exposure of the greater trochanter of the femur was distinguished according to the degree of exposure of the greater trochanter of the femur inside and outside the vertical line.Group Ⅰ(52 hip joints,with a large degree of exposure) was outside the lin e,and Group Ⅱ(122 hip joints,with a small degree of exposure) was inside the line.The iliac crest occlusion angle was Δ1=|∠1-∠2|,and according to the proximal femoral nail anti-rotation with a 5°proximal late ralization angle was grouped,with △1≤5° as group Ⅱa(66 hips),and Δ1>5° as group Ⅱb(56 hips).RESULTS AND CONCLUSION:(1) The valu es of La,La/Lband Δ1in Group Ⅰ were lower than those in Group Ⅱ(P <0.05);the value of La/Lbin Group Ⅱawas higher than that in Group Ⅱb(P <0.05);the value of Δ1in Group Ⅰ was higher than that in Group Ⅱa(P <0.05) and lower than that in Group Ⅱb(P <0.05);the val

关 键 词：解剖学 髂嵴 股骨大转子 髓内钉 X射线片 

分 类 号：R445.4[医药卫生—影像医学与核医学] R322.71[医药卫生—诊断学] R683.42[医药卫生—临床医学]