老年髋部骨折患者股骨近端形态学参数的评估

Evaluation of the proximal femur geometry in patients with elderly osteoporotic hip fractures

目的 探讨老年髋部骨折患者股骨近端几何结构对髋部骨折发生的影响.方法 选取2015年5至12月于北京积水潭医院创伤骨科就诊的65岁以上的老年患者137例,其中髋部骨折患者69例,未骨折患者68例,均行CT扫面并运用Mimics软件进行三维重建和形态学参数测量,包括股骨颈宽度、股骨颈长度、颈干角、股骨头高度、股骨头直径和Offset,并对两组之间的参数进行统计学分析.结果 髋部骨折组和对照组经单因素分析显示年龄、性别、股骨颈长度、股骨头直径、颈干角、Offset差异均有统计学意义（均P〈0.05）.对差异有统计学意义的参数经多因素Logistic回归分析显示年龄、性别、股骨颈长度、颈干角与骨折呈正相关（P〈0.05）,是骨折发生的独立危险因素.ROC曲线分析结果显示年龄、股骨颈长度、颈干角的曲线下面积值（AUC值）分别为0.818、0.818和0.725,对预测髋部骨折的防治具有一定的意义.结论 年龄越大、股骨颈长度越长、颈干角越大越容易发生髋部骨折,并且利用Mimics软件对股骨近端CT数据进行三维重建和测量是一种有效可行的测量方法.

Objective To investigate the relationship between the proximal femur geometry and elderly osteoporotic hip fractures.Methods From May 2015 to December 2015,137 patients with elderly osteoporotic hip fractures were involved.69 cases were in the fracture group and 68 cases were in the control group.CT scan were performed on all patients and the proximal femur geometry parameters were measured, including the neck width （NW）, neck length （NL）, neck shaft angle （NSA）, femur head diameter （FHD）, head height （HH） and Offset.Statistical analysis was performed between two groups.Results The results of single factor analysis showed that age, sex, NL, FHD, NSA and Offset had significantly differences between two groups （P〈0.05）.The multiple Logistic regression analysis showed that age, sex, NL and NSA were independent risk factor for the hip fractures.The ROC curve analysis showed that area under curve （AUC） were 0.818, 0.818 and 0.725, respectively.Conclusions The patients with older age, longer NL and larger NSA might be prone to hip fracture and it was an effective and feasible method to reconstruct and measure the CT data of the proximal femur with Mimics software.