股骨颈径相参数测量及其在股骨颈置钉选择中的意义

The measurement of femoral neck's diameter and its value to optimise the selection of internal fixation

目的了解华中地区成人股骨颈解剖特点以指导临床髋部骨折的治疗。方法测量34具股骨标本、150幅成人正常髋关节计算机断层扫描图像和774幅成人正常骨盆X线图像,获取股骨颈平均最小前后径和最小上下径,结合股骨近端髓内钉和联合交锁加压髓内钉的双螺钉外间距,Gamma钉和股骨近端防旋髓内钉的拉力螺钉直径,初步探讨股骨颈解剖学特点在髋部骨折治疗中的意义。结果股骨标本股骨颈平均最小前后径为(24.08±2.24)mm,平均最小上下径为(30.61±2.77)mm。计算机断层扫描图像股骨颈平均最小前后径为(24.70±2.89)mm,平均最小上下径为(30.56±3.76)mm。X线图像股骨颈平均最小上下径为(35.73±3.98)mm。21位同时行计算机断层扫描与X线照射的成人的计算机断层扫描图像股骨颈平均最小上下径D左=(30.40±3.30)mm,D右=(30.61±3.84)mm;X线图像股骨颈平均最小上下径d左=(36.17±4.93)mm,d右=(36.43±5.12)mm,X线相对计算机断层扫描有放大作用,放大率为19%(<0.01)。股骨近端髓内钉的双螺钉外间距为22mm,联合交锁加压髓内钉的双螺钉外间距为15.25mm,Gamma钉和股骨近端防旋髓内钉的拉力螺钉直径为10.5mm。结论对股骨颈直径细小的某些身材矮小的女性股骨转子间骨折患者,建议选择股骨颈单钉置入内固定器材。

Objective The anatomic parameters of the femoral necks of the adults in the central China region are collected to treat the hip fracture better. Methods Collect data of minimal suprainferior and anteroposterior diameter of femoral necks by measuring femoral necks of cadavers(n=34), normal computed tomography scan image of hip joint of adults(n=150) and normal X-Ray image of pelvis of adults(n=774). Then compare with the maximal distance between two lag screws of proximal femoral nail and intertrochanteric antegrade nail, as well the diameter of lag screw of gamma nail and proximal femoral nail antirotation, to learn the anatomic parameters of the femoral necks and study their characteristics in internal fixation of hip fracture. Results The mean minimal anteroposterior and suprainferior diameter of 34 cadaveric femoral necks are(24.08±2.24) mm and(30.61±2.77) mm respectively. The mean minimal anteroposterior diameter of femoral necks of 150 adults on normal computed tomography scan images is(24.70±2.89) mm and the mean minimal suprainferior diameter is(30.56±3.76) mm. The mean minimal suprainferior diameter of femoral necks of 774 adults on normal X-Ray images is(35.73±3.98) mm. The mean minimal suprainferior diameter of bilateral femoral necks of 21 adults, who have both computed tomography scan and X-Ray image, is Dleft=(30.40±3.30) mm and Dright=(30.61±3.84)mm on computed tomography scan images, and dleft=(36.17±4.93) mm and dright=(36.43±5.12) mm on X-Ray images.The image has been amplified in radiography comparing to the computed tomography scan and the magnification is 19%( <0.01). The maximal distance between two lag screws of proximal femoral nail and intertrochanteric antegrade nail are22 mm and 15.25 mm respectively, the diameter of lag screw of gamma nail and proximal femoral nail antirotation is10.5mm. Conclusion It's maybe better to select the one lag screw fixation to treat the femoral intertrochanteric fracture of some diminutive female patient whose femoral neck is very narrow.