中老年股骨转子间骨折患者股骨近端解剖参数的性别和年龄差异研究

Gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture

目的比较中老年股骨转子间骨折患者股骨近端解剖参数的性别和年龄差异,以期为内固定器械的研发提供理论支持。方法回顾性分析2009年9月至2017年3月期间解放军总医院第一医学中心骨科收治的375例股骨转子间骨折患者资料。按不同年龄段将患者分为4组:中年(45~59岁)组22例,男16例,女6例;老年前期(60~74岁)组87例,男37例,女50例;老年(75~89岁)组238例,男76例,女162例;长寿老年(≥90岁)组28例,男6例,女22例。通过影像学资料测量患者的股骨颈前倾角、股骨颈干角、股骨头直径、股骨颈长度、股骨颈偏移量及股骨颈宽度。比较同一组内不同性别之间及同一性别不同组别之间患者股骨近端解剖参数的差异。结果男性与女性中老年股骨转子间骨折患者的体重指数和骨折AO分型比较差异均无统计学意义(P>0.05),具有可比性。中老年男性股骨转子间骨折患者的股骨颈前倾角(8.33°±5.00°)显著小于女性患者(11.28°±6.15°),股骨头直径、股骨颈长度、股骨颈偏移量、股骨颈宽度[(49.10±2.48)、(99.70±5.22)、(7.18±2.20)、(39.10±4.92)mm]显著大于女性患者[(43.46±2.79)、(90.00±4.75)、(6.29±2.07)、(33.49±4.87)mm],差异均有统计学意义(P<0.05)。中年组、老年前期组、老年组、长寿老年组男性患者股骨头直径、股骨颈长度、股骨颈宽度显著大于女性患者,老年前期组、老年组、长寿老年组男性患者股骨颈前倾角显著小于女性患者,老年组男性患者股骨颈偏移量显著大于女性患者,差异均有统计学意义(P<0.05)。同一性别不同组之间患者的股骨颈前倾角、股骨颈干角、股骨头直径、股骨颈长度、股骨颈偏移量及股骨颈宽度比较差异均无统计学意义(P>0.05)。结论与中老年男性相比,中老年女性股骨转子间骨折患者的股骨颈前倾角偏大,股骨颈偏移量、宽度、长度及股骨头直径偏小。中老年股骨转子间骨折患者股骨近端的解剖参数无明显年龄差异。

Objective To determine the gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture so as to provide theoretical evidence for development of internal fixation devices.Methods The clinical and CT data of 375 patients with intertrochanteric fracture were analyzed retrospectively who had been treated at Department of Orthopedics,The First Medical Center,General Hospital of Chinese PLA from September 2009 to March 2017.The patients were divided into 4 age groups.The middle-aged group(from 45 to 59 years old)had 22 cases,16 males and 6 females;the early elderly group(from 60 to 74 years old)had 87 cases,37 males and 50 females;the elderly group(from 75 to 89 years old)had 238 cases,76 males and 162 females;the late elderly group(≥90 years old)had 28 cases,6 males and 22 females.The anteversion angle of femoral neck,femoral neck-shaft angle,femoral head diameter,femoral neck length,femoral neck offset and femoral neck width were measured on their images.The anatomical parameters of proximal femur were compared between genders in the same age group and between groups of the same gender.Results There were no significant differences between male and female patients with femoral intertrochanteric fracture in body mass index or AO classification,showing comparability(P>0.05).The anteversion angle of femoral neck(8.33°±5.00°)of the male middle-aged and elderly patients with intertrochanteric fracture was significantly smaller than that of the female ones(11.28°±6.15°),but their femoral head diameter,femoral neck length,femoral neck offset and femoral neck width(49.10 mm±2.48 mm,99.70 mm±5.22 mm,7.18 mm±2.20 mm and 39.10 mm±4.92 mm)were significantly larger than those of the female ones(43.46 mm±2.79 mm,90.00 mm±4.75 mm,6.29 mm±2.07 mm and 33.49 mm±4.87 mm)(all P<0.05).The femoral head diameter,femoral neck length and femoral neck width of the male patients in all the 4 age groups were significantly larger than those of the female ones(P<0.05).The anteversion angles of femoral neck of the male patients in the early elderly,elderly and late elderly groups were significantly smaller than those of the female ones(P<0.05).The femoral neck offset of male patients in the elderly group was significantly greater than that of female ones(P<0.05).There were no statistically significant differences in anteversion angle of femoral neck,femoral neck-shaft angle,femoral head diameter,femoral neck length,femoral neck offset or femoral neck width between groups of the same gender(P>0.05).Conclusions Compared with the middle-aged and elderly male patients with femoral intertrochanteric fracture,the middle-aged and elderly female ones have a larger anteversion angle of femoral neck,smaller offset,width and length of femoral neck,and a smaller femoral head diameter.There are no significant age differences in anatomical parameters of the proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture.