倒三角空心钉内固定治疗股骨颈骨折的影像学研究  

Imaging study of internal fixation with inverted triangular hollow screws for femoral neck fractures

作　　者：谢凯[1] 杨家赵 高庆 李黎[1] 徐磊[1] 方诗元 XIE Kai;YANG Jiazhao;GAO Qing;LI Li;XU Lei;FANG Shiyuan(Department of Orthopaedics,the First Affiliated Hospital of University of Science and Technology of China,Hefei,Anhui 230001,China;不详)

机构地区：[1]中国科学技术大学附属第一医院骨科,安徽合肥230001 [2]六安市人民医院骨科,安徽237000

出　　处：《中国骨与关节损伤杂志》2023年第6期566-570,共5页Chinese Journal of Bone and Joint Injury

基　　金：安徽省科技攻关项目(1401045022)。

摘　　要：目的 分析倒三角空心钉治疗股骨颈骨折患者的影像学资料,对股骨近端形态、空心钉固定的合适位置以及术中透视进行研究,为临床操作提出依据和建议。方法 回顾性分析自2018-01—2020-06采用倒三角空心钉内固定治疗的13例成年股骨颈骨折,采用Mimics和Siemens NX软件对患者健侧股骨CT影像学资料进行处理分析,主要包括股骨近端形态、空心钉固定的合适位置以及模拟术中C型臂X线机透视判断后上方螺钉的安全性。结果 13例健侧股骨CT资料均予以软件处理分析,自股骨颈基底部至头下位置,股骨颈的形态是不断变化的,存在面积大小的变化和形态的变化;不同界面沿着股骨颈轴线进行投影并得到了最小投影面;模拟空心钉置入显示前上方螺钉高于后上方螺钉位置;在侧位片上,前上方螺钉较后上方螺钉距离股骨距螺钉远。模拟术中X线透视,额外单独固定的透视角度无法精确验证后上方螺钉是否穿透皮质,需要在正侧位透视之间的范围连续逐渐增加角度进行透视,能够最大限度地验证后上方螺钉的准确性。结论 采用倒三角空心钉内固定治疗成人股骨颈骨折时以股骨颈最小投影面为参考进行空心钉位置选择时,建议在股骨颈正位片上,前上方螺钉应高于后上方螺钉位置;在侧位片上,前上方螺钉较后上方螺钉距离股骨距螺钉远,有助于保护股骨颈后上方血管。术中应在正侧位透视基础上,逐渐连续透视能够充分评估螺钉的位置。创伤骨科医师在临床上进行股骨颈骨折空心钉内固定时,应意识到后上方螺钉可能存在“in-out-in”的现象,需正确认识股骨颈的形态,遵循空心钉置入的原则。Objective To analyze imaging data of patients with femoral neck fractures treated with inverted triangular hollow screws and investigate the morphology of the proximal femur,the appropriate position of hollow screw fixation,and intraoperative fluoroscopy to provide a basis and recommendations for clinical operation.Methods The retrospective analysis of 13 adult femoral neck fractures treated with internal fixation using inverted triangular hollow screws from January 2018 to June 2020 was performed.Mimics and Siemens NX software were used to process and analyze the patients′ CT imaging data of the femur,mainly including the proximal femoral morphology,the appropriate position of hollow screw fixation,and the safety of the posterior superior screw judged by intraoperative C-arm X-ray machine fluoroscopy.Results All 13 femoral CT data were processed and analyzed by software.From the base of the femoral neck to the subhead position,the morphology of the femoral neck was constantly changing,with variations in area size and morphology;different interfaces were projected along the axis of the femoral neck and the minimum projection plane was obtained;simulated hollow screw placement showed that the anterior superior screw was higher than the posterior superior screw position;on the lateral slice,the anterior superior screw was further away than the posterior superior screw The femoral moment screw was farther away.The simulated intraoperative X-ray fluoroscopy with additional fixed fluoroscopic angles alone could not accurately verify the penetration of the posterior superior screw into the cortex,and successive gradual increases in angle in the range between the frontal and lateral fluoroscopy were required to maximize the accuracy of the posterior superior screw.Conclusion In the hollow screw position study in inverted triangular hollow screw internal fixation for the treatment of adult femoral neck fractures with the minimal projection plane of the femoral as a reference,it is recommended that on the orthogonal vie

关 键 词：股骨颈骨折 空心钉 内固定 影像学 透视 

分 类 号：R687.3[医药卫生—骨科学]