NeuViz 16螺旋CT髋部定量骨密度与髋螺钉置入位置的临床研究

Clinical Study of Neu Viz 16 Screw CT the Quantitative Bone Mineral Density of the Hip and Hip Screw Placement

目的使用Neu Viz16螺旋CT对髋部不同空间位置骨松质进行骨密度测定,通过骨密度角度探讨内固定术对治疗老年股骨粗隆间骨折时髋螺钉位置的合理安放。方法选取我院骨科股骨粗隆间骨折患者50例患者与50例健康人采用Neu Viz16螺旋CT进行双侧髋部扫描并测定从髋螺钉入口至股骨头的CT值。对股骨头内密度较高的压力骨小梁及其内、外、前、后方五个区域的骨松质做定量CT骨密度测定。结果骨折组从髋螺钉入口内侧到股骨头下区域的CT值为负值。骨折组PCT及其内、外、前、后侧的定量CT骨密度分别为(230.72±55.54)、(65.13±25.32)、(38.51±21.98△)、(78.95±25.98*)、(79.07±19.92*)mg/cm3,而对照组分别为(297.35±43.32)、(84.21±27.90)、(70.03±20.71▲)、(99.82±27.31#)、(98.71±29.58#)mg/cm3。两组PCT的骨密度均明显高于其周围4个区域(P<0.01)。骨折组5个区域骨密度均明显低于对照组(P<0.01)。结论从骨密度角度进行分析发现,从髋螺钉入口至股骨头下这一区域的组织密度较软组织密度更低,因此对置入的髋螺钉无锚定力量。骨小梁作为髋部密度最高的骨松质,对髋螺钉锚定力量发挥最主要作用。在股骨头外上方、前方及后方3个范围内,骨松质密度显著低于压力骨小梁是髋螺钉发生切割的危险区域。患者中尤其以老年患者为主可能发生严重的骨小梁退变,选择正确放置髋螺钉的位置对促进骨折恢复,改善患者预后情况及受损功能恢复情况具有重要意义。

Objective To use Neu Viz 16 screw CT to measure bone mineral density of cancellous of different space position of hip, the reasonable placement of hip screw in the treatment of senile intertrochanteric fracture. Methods 50 cases of patients with intertrochanteric fracture of femur of orthopaedics in our hospital and 50 cases of healthy people were used Neu Viz 16 screw CT to scan bilateral hip and measure CT values from the hip screw entry to the femoral head. A quantitative CT bone mineral density of pressure trabecular with higher density of he femoral head and the inner, outer, front and rear five regions was measured. Resultsesults The CT value of the femoral head from the entrance to the femoral head of the fracture group was negative. Quantitative CT bone density of PCT in the fracture group and its internal, external, anterior and posterior were respectively（230.72±55.54）、（65.13±25.32）、（38.51±21.98△）、（78.95±25.98＊）、（ 79.07±19.92＊）mg/cm3,and the control group, respectively（297.35±43.32）、（84.21±27.90）、（70.03±20.71▲）、（99.82±27.31#）、（98.71±29.58#）mg/cm3. The bone mineral density of PCT of two groups were respectively significantly higher than those of the 4 regions around（P〈0.01）. The bone mineral densities of five regions of the fracture group were significantly lower than those of the control group（P〈0.01）. Conclusiononclusion Analysis of bone mineral density shows the tissue density of this region from the entrance to the femoral head is lower than that of the soft tissue density, therefore, the placement of the hip screw has no anchoring force. Trabecular bone as the highest density of bone cancellous bone has the most important role of anchor force of hip screw. The top outside of the femoral head, the front and the rear of 3 ranges, the density of cancellous bone was significantly lower than that of the trabecular bone,which is a risk area for the occurrence of hip screws. Among patients, especially in elderly patients,there may be severe bone degeneration, choosing the correct position of placing the hip screw can promote the recovery of the fracture, improve the prognosis of patients and has significance to the recovery of damaged function.