股骨髓内钉近端不同方向锁钉的相关影像解剖研究

Correlative image anatomy of interlocking nail in different directions at the proximal end of femoral intramedullary nail

目的为了将股骨髓内钉近端螺钉置入小粗隆增加内固定稳定性,本研究利用高端CT影像测量了股骨近端部分解剖参数,为改进髓内钉近端锁钉的置钉位置提供影像学依据。方法收集2015年6月~2015年12月在我院行髋关节CT扫描结果正常的成年患者45例,取双侧股骨近端数据研究,对相关数据进行测量,并计算股骨近端普通皮质厚度、经小粗隆皮质厚度等行统计学分析。结果小粗隆水平普通股骨横径为(3.62±0.39)cm,经小粗隆最大股骨横径为(4.60±0.43)cm,经小粗隆最大股骨横径较普通股骨横径大,两者间有统计学差异(t=38.52,P<0.05);股骨上段普通皮质厚度为(1.32±0.35)cm,经小粗隆皮质厚度为(2.58±0.50)cm,小粗隆后倾角为(17.85±4.06)°,经小粗隆皮质厚度较普通皮质厚度大,两者间有统计学差异(t=28.46,P<0.05)。结论股骨近端解剖变异大,在本研究中小粗隆后倾角为(17.85±4.06)°,如想将螺钉置入小粗隆,此为最佳方向;股骨近端经小粗隆最大横径较普通股骨横径明显大,可以置入更长的螺钉;经小粗隆皮质厚度也较普通皮质厚度更厚。

Objective To implant the nail at the proximal end of femoral intramedullary nail into the small trochanter to increase the stability of internal fixation, proximal femoral anatomical parameters were measured by high-end CT images, to provide an imaging basis for improving the location of the proximal nail in the intramedullary nail. Methods A total of 45 cases of adult patients with normal hip CT scan in our hospital from June 2015 to December 2015 were col- lected. Bilateral femoral proximal data were collected. The related data were measured. The proximal femur ordinary cortex thickness, the thickness of the small trochanter cortex were statistically analyzed. Results The diameter of the common femur in the small trochanter level was （3.62±0.39）cm, and the largest femur diameter via small trochanter was （4.60±0.43）cm. And the largest femur transverse diameter via small trochanter was larger than that of the common fe mur, and there was significant difference between the two groups （t=38.52, P〈0.05）. The ordinary cortex thickness of the upper femur was （1.32±0.35） cm, and the cortex thickness via the small trochanter was （2.58±0.50） cm, and the posterior inclination of small trochanter was （17.85±4.06）°. The cortex thickness via the small trochanter was larger than that of the ordinary cortex thickness, and there was significant difference between the tWO groups （t=28.46, P.〈0.05）. Conclusion The proximal femoral anatomical variation is large. In this study, the small trochanter inclination angle is（17.85±4.06）°. If the nail is to be screwed into small trochanter, this is the best direction. The maximum transverse diameter via the trochanter is larger than that of the ordinary femur at the proximal end, and the longer screw can be inserted. The cor- tex thickness via the small trochanter is also thicker than that of the ordinary cortex.