股骨颈骨折解剖分型与骨质疏松程度关系的临床研究

Research of the relationship between anatomical types of femoral neck fractures and degree of osteoporosis

目的：探讨股骨颈骨折解剖类型与骨质疏松程度的关系。方法回顾性研究首都医科大学附属北京朝阳医院骨科2008年7月—2012年12月58例股骨颈骨折患者 X 线资料及术后股骨头标本,其中男24例、女34例,年龄48~88岁。按骨折形态进行解剖分型,结合标本 X 线与患者术前 X 线进行 Singh 指数分级,分析骨折的解剖类型分布、骨质疏松程度及两者之间的关系。结果解剖分型中头颈型占58.6%（34/58）,头下型占19.0%（11/58）,观察到一种新的解剖类型———“特殊型”占20.7%（12/58）,不能分型者1例,无经颈型。 Singh 指数Ⅳ级以下者占94.8%（55/58）,Ⅴ级占5.2%（3/58）,无 Singh 指数Ⅵ级者。 Singh 指数Ⅰ~Ⅱ级和Ⅲ~Ⅴ级时,头下型股骨颈骨折的所占比例分别是6/8和10.0%（5/50）,头颈型股骨颈骨折的所占比例分别是1/8和66.0%（33/50）,差异均有统计学意义（χ2=14.966,χ2=6.082, P 值均〈0.05）；结论头颈型在股骨颈骨折中最常见。新解剖类型———“特殊型”的形态特点：外周骨折线位于头下,中央部压力骨小梁凸出伸向股骨颈,末端稍钝。 Singh 指数Ⅳ级以下时易发生股骨颈骨折,Ⅴ~Ⅵ级时不易发生股骨颈骨折。股骨颈骨折解剖类型与骨质疏松程度密切相关,Singh 指数Ⅰ~Ⅱ级时倾向于发生头下型骨折,Ⅲ~Ⅴ级时倾向于发生头颈型骨折。

Objective To investigate the relationship between anatomical types of femoral neck fractures and degree of osteoporosis. Methods Fifty-eight specimens of postoperative femoral heads collected from July 2008 to December 2012 were enrolled in the research, including 24 males and 34 females with age ranging from 48 to 88 years （average 74. 7 years） . All of the samples were classified according to anatomical classification firstly, and then Singh index classification was conducted through combining preoperative X-ray and specimens＇ X-ray. The proportions of every anatomical type and degree of osteoporosis were explored. Lastly, the relationship between them was analyzed. Results Analysis of anatomical types showed that the proportion of head-neck type was 58. 6% （34 / 58）, the sub-head type was 19. 0% （11 / 58）, and a new type called ＂ special type＂ was discovered, which accounted for 20. 7% （12 /58）. The rest one case was undetermined type and there was no via-neck type. The analysis of Singh index revealed that samples below grade Ⅳ accounted for 94. 8% （55 / 58）, the grade V was 5. 2% （3 / 58） and no case of grade Ⅵ was found. The proportions of sub-head type of femoral neck fractures were 6 / 8 and 10. 0%（5 / 50）, respectively, in ones whose Singh index were grades Ⅰ - Ⅱ and grades Ⅲ - Ⅴ, the difference was statistically significant （χ2 = 14,966, P 〈 0. 01）, while the proportions of head-neck type in the two groups were 1 / 8 and 66. 0% （33 / 50）,respectively , the difference was also statistically significant （χ2 =6. 082, P 〈 0. 05）. Conclusions Head-neck type is the most common anatomical type of femoral neck fractures. The new anatomical type discovered in this research is tentatively called ＂ special type＂ , whose peripheral fracture surface locates below the femoral head and the central part of compressive trabecular bone stretches into distance of the femoral neck, with a relatively blunt tip. Patients, whose Singh index of gradeⅣ or below are prone to suffer from femoral neck fractures, while those of grades Ⅴ and Ⅵ are not. The anatomical types of femoral neck fractures are closely related to the degree of osteoporosis, sub-head type often occurs in ones whose Singh index are grades Ⅰ - Ⅱ, while typical head-neck type in grades Ⅲ - Ⅴmore easily.