股骨近段髓腔解剖参数测量与不同类型人工股骨假体的选择

The measurement of proximal femoral medullary cavity and the selection of different types of femoral prosthesis

目的对414例股骨近段髓腔解剖特征的X线影像学测量,为临床合理选择股骨假体提供参数。方法随机选择414例苏州大学附属第一医院骨科2005年3月～2008年12月期间股骨近端DR影像资料(DICOM格式),用Dicom viewer软件测量10项股骨近段髓腔径长参数和5项形态参数,分析各参数的特点、相关性及与性别、年龄的关系。结果 (1)年龄因素(女性)和峡部内径显著正相关,随着年龄增长,小粗隆中点下方20 mm处髓腔至峡部髓腔内径变宽大,整个股骨近端髓腔呈宽而直的烟囱型。(2)MCFI集中于1.8～2.4,占总的被测人群68.08%。(3)本组所测CFI,根据Nobel分型,烟囱型髓腔占13.0%,正常型髓腔占72.5%,漏斗型髓腔占14.5%。(4)MCFI和CFI显著正相关,MCFI和DCFI无显著相关性;CFI和DCFI、股骨远端髓腔开大角度显著正相关,CFI和峡部内径显著负相关;DCFI和股骨远端髓腔开大角度显著正相关。结论 (1)股骨近端髓腔形态、大小变异较大,国人之间及与欧美白种人群之间均存在一定的差异。(2)MCFI、CFI、DCFI对描述股骨近端髓腔形态各有侧重,三者结合髓腔径长参数能更准确、细致地刻画髓腔形态。

Objective Through the study of the X-ray measurement of the anatomical parameters of 414 proximal femoral medullary cavity to provide evidence to the selection of geometric types and design of artificial femoral prosthesis. Methods Randomly select the X-ray DICOM data of proximal femoral pre-operatively of 414 cases which has undergone THA from March 2005 to December 2008 in First Affiliated Hospital of Suzhou University , measure 10 parameters of diameter and five morphologic parameters of the proximal femoral medullary cavity with DICOM VIIEWER software, and analyze the correlation among various parameters of proximal femoral and the correlation with gender and age. Results （1）There was significant positive correlation between the factor of age （female） with the internal diameter of isthmus. （2） MCFI mainly in 1.8 -2.4）, possessed 68.1% of all the test people. （3）According to Nobel＇classification of proximal femoral medullary cavity, chimney-type （CFI〈3.0） occupied 13.0%, the normal type （3.0〈CFI〈4.7） occupied 72.5%, funnel-shaped （CFI〉4.7） occupied 14.5%. （4）MCFI and CFI showed strong positive correlation, but there was no significant correlation between MCFI and DCFI; CFI showed strong positive correlation with DCFl,and the opening angle of distal femoral ; CFI showed strong positive correlation with internal diameter of isthmus; DCFI had significant correlation with the opening angle of distal femoral medullary cavity. Conclusion （1）There was significant variation in the shape and size of proximal femoral medullary cavity, and there was diference between Chinese and Caucasian to a certain degree. （2）MCFI （ metaphyseal canal flare index） and CFI （canal flare index） and DCFI （distal canal flare index） had different emphases on describing the morphological characteristics of proximal femoral medullary cavity, and the three index combined with the parameters of diameter of proximal femoral medullary cavity could describe the shape of medullary cavity more accurately.