股骨头颈CT测量值在DHS导针定点定向中的应用

The Application of CT Value of Femoral Head and Neck in the Orientation of DHS

目的:利用正常髋部CT测量值了解股骨头、颈、粗隆彼此相关的形态特征,为临床应用DHS确定导针进针点和方向提供依据。方法:对80例正常髋部CT进行测量,算出比值并进行统计学检验,再选择80例股骨粗隆部骨折患者为研究对象,随机分为新法组40例(按新法设计导针方向和角度进针)和对照组40例(传统导针方向和角度进针)。并对2组患者手术时间、术中影像次数、功能评分(按髋关节创伤后的功能评分(Sanders)标准评定)进行比较。结果:经研究发现,CT测量后的比值比较差异具有统计学意义,并且依照这个比值将导针置入新法组,2组均通过术后随访1.5年,结果新法组优良率97.5%,对照组优良率85%,两组功能评分比较差异有统计学意义(P<0.05),新法组手术时间短于对照组、术中放射线次数少于对照组、功能评分高于对照组。结论:股骨头颈CT测量值指导术中DHS导针置入定点定位的手术技巧,手术时间明显缩短,术中放射线次数明显减少、患者恢复伤前工作能力及生活自理能力明显提高,在简化手术步骤和提高手术效率中均具有重要临床意义。

Objective：To understand the morphological characteristic of femoral head,neck,trochanter by the CT value of the normal hip,and guide to the orientation of DHS.Methods：Normal CT values of Hip in 80 cases were measured and the ratios were statistically calculated.80 cases with intertrochanteric fractures were randomly divided into the new group（the orientation of DHS were renewed） and the control group（the orientation of DHS were designed as usual）.operative time、times of intraoperative imaging and the functional scores（according to Sanders standard assessment） were measured for all the patients.The effect were assessed by Pain、strength of muscle、daily activities、X-ray measurements and posture of walk.Results：There were significant differences in the CT value between the new group and the control group.All the patients were followed up for 1.5 years,the fine rate was 97.5% in the new group,and the fine rate was 85% in the control group.There were significant differences in the functional score between the two group（P0.05）.The operative time was shorter in the new group than that in the control group,the number of intraoperative radiation were less than that in the control group,the functional scores were higher than that in the control group.Conclusions：Orientation of DHS guided by CT value was simplified,the surgical time was significantly shortened,the numbers of intraoperative radiation were significantly reduced,and the ability of daily activities was significant improved.