髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学的关系

Relationships of Singh index to the geometric structure of the proximal femur and the biomechanics of the load-bearing area in elderly patients with hip fracture

目的:探讨髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学的关系。方法:选取82例髋部骨折老年患者(观察组)与41例既往存在闭合性髋部骨折史青壮年者(对照组)的临床资料进行回顾性分析,对比Singh指数分级、股骨近端几何结构指标(股骨颈轴长、颈干角、颈长、内侧偏距)及承重区生物力学指标(骨极限应力、弹性模量),分析Singh指数与股骨近端几何结构指标、承重区生物力学指标的关系。结果:观察组Singh指数分级中Ⅱ、Ⅲ级占比高于对照组,而Ⅳ、Ⅴ、Ⅵ级占比低于对照组(P<0.05);观察组Singh指数、颈干角、骨极限应力、弹性模量低于对照组,而股骨颈轴长、内侧偏距、颈长高于对照组(P<0.05)。分层回归显示,颈干角、骨极限应力、弹性模量会对Singh指数产生显著的正向影响关系,而股骨颈轴长会对Singh指数产生显著的负向影响关系(P<0.05)。结论:髋部骨折老年患者Singh指数与股骨近端几何结构及承重区生物力学具有密切关系,Singh指数的降低会严重影响患者的股骨近端几何结构及承重区生物力学。

Objective To investigate the relationships of Singh index to the geometric structure of the proximal femur and the biomechanics of the load-bearing area in elderly patients with hip fracture. Methods The clinical data of 82 elderly patients with hip fracture(observation group) and 41 young adults with a history of closed hip fracture(control group) were selected for retrospective analysis. The grading by Singh index, the geometric structure indexes of the proximal femur(femoral neck axial length, neck-shaft angle, neck length, medial offset) and the biomechanical indexes of the load-bearing area(bone ultimate stress, elastic modulus) were compared. Moreover, the relationships of Singh index to the geometric structure indexes of the proximal femur and the biomechanical indexes of the load-bearing area were analyzed. Results According to grading by Singh index, the proportions of grades II and III in observation group were higher than those of control group,while the proportions of grades IV, V and VI were lower than those of control group(P<0.05). Compared with control group,observation group had lower Singh index, neck-shaft angle, bone ultimate stress and elastic modulus, but higher femoral neck axial length, medial offset and neck length(P<0.05). Hierarchical regression showed that the neck-shaft angle, bone ultimate stress and elastic modulus were positively related to Singh index, while the femoral neck axial length had significant negative relationships with Singh index(P<0.05). Conclusion The Singh index of elderly patients with hip fracture is closely related to the geometric structure of the proximal femur and the biomechanics of the load-bearing area. The decrease of Singh index will significantly affect the geometric structure of the proximal femur and the biomechanics of the load-bearing area.