摘要
目的用股骨转子间骨折CT三维重建技术,研究前内侧角骨皮质的形态特征,为进一步研究皮质支撑复位理论提供参考依据。方法回顾分析2016年1月-2019年1月收治的75例影像资料完整的不稳定型股骨转子间骨折患者的CT数据,其中男32例,女43例;年龄65~98岁,平均79.8岁。根据2018版国际内固定研究协会/美国骨创伤协会(AO/OTA)分型:31-A2.2型46型,31-A2.3型29例。对CT数据进行分割建模、模拟复位等影像处理技术,测量其前内侧角处骨皮质的厚度,前壁骨折线与冠状位水平线成角,内侧壁骨折线与矢状位水平线成角,内侧壁可获支撑的皮质宽度,并观察前内侧角处骨折近端的骨皮质断面形态。结果前壁骨折线与冠状位水平线成角为51.8~72.6°,平均62.4°;内侧壁骨折线与矢状位水平线成角为17.6^-47.3°,平均-15.8°;前内侧角处骨皮质厚度为3.6~6.1mm,平均4.4mm;内侧壁可获支撑的皮质宽度为14.3~21.2mm,平均16.8mm。前内侧角处骨折近端的骨皮质断面有3种形态:(1)与股骨颈轴线成角>90°,57例(76.0%);(2)与股骨颈轴线相垂直,7例(9.3%);(3)与股骨颈轴线成角<90°(包括反向成角),11例(14.7%)。结论CT三维重建能清晰显示股骨转子间骨折的皮质形态和骨折线的走向,能提示股骨转子间骨折复位后的稳定性,对手术选择皮质支撑复位的形式有较好的指导作用。
Objective To study the anteromedial cortical morphology of intertrochanteric fracture with CT three-dimensional reconstruction technique, and to provide a reference for further study of cortical buttress reduction theory. Methods CT data of 75 patients with unstable intertrochanteric fracture with complete imaging data treated between January 2016 and January 2019 were retrospectively analyzed, including 32 males and 43 females, aged 65-98 years(mean, 79.8 years). According to AO/Orthopaedic Trauma Association typing of 2018 edition, there were 46 cases of31-A2.2 type and 29 cases of 31-A2.3 type. The image processing techniques such as segmentation modeling and virtual reset were performed. The thickness of the cortex at the anteromedial corner, the angle between the anterior wall fracture line and the coronal horizontal line, the angle between the medial wall fracture line and the sagittal horizontal line, the width of the cortex supported by the medial wall were measured, and the morphology of the cortical bone at the anteromedial corner were observed. Results The angle between the anterior wall fracture line and the coronal horizontal line was 51.8-72.6°, with an average of 62.4°;the angle between the medial wall fracture line and the sagittal horizontal line ranged from 17.6° to –47.3°, with an average of-15.8°;the thickness of the cortex at the anteromedial angle was 3.6-6.1 mm, with an average of 4.4 mm;and the width of the cortex supported by the medial wall was 14.3-21.2 mm, with an average of 16.8 mm. The morphology of the cortical bone at the anteromedial corner had 3 forms: angle with femoral neck axis >90°, 57 cases(76.0%);perpendicular to femoral neck axis, 7 cases(9.3%);angle with femoral neck axis <90°(including reverse angle), 11 cases(14.7%). Conclusion CT three-dimensional reconstruction can clearly show the cortical morphology and the direction of the fracture line of intertrochanteric fracture, which can indicate the stability of the intertrochanteric fracture after reduction, and ha
作者
王欣
张英琪
张世民
杜守超
陈凯
王志远
WANG Xin;ZHANG Yingqi;ZHANG Shimin;DU Shouchao;CHEN Kai;WANG Zhiyuan(Department of Orthopedics,Tongji Hospital of Tongji University,Shanghai,200065,P.R.China;Department of Orthopedics,Yangpu Hospital,Tongji University,Shanghai,200090,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第10期1260-1264,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81772323)~~
关键词
股骨转子间骨折
前内侧角骨皮质
骨折形态
复位支撑
内固定
Intertrochanteric fracture
anteromedial corner cortex
morphology of fracture
cortex buttress reduction
internal fixation
