股骨近端髓内钉治疗股骨粗隆间骨折的影像学分析

doi:10.3969/j.issn.1671-167X.2015.02.014

摘要/Abstract

摘要： 目的：建立一种股骨近端三维解剖形态的测量方法，研究InterTAN髓内钉和股骨近端防旋髓内钉(proximal femoral nail anti-rotation，PFNA)手术对股骨近端解剖形态的影响。方法：利用Mimics等计算机辅助设计（computer assisted design，CAD）软件，建立一种在三维条件下，测量股骨近端三维（3 dimensional，3D）解剖形态的方法，并完成信度实验。收集40例股骨粗隆间骨折患者行InterTAN和PFNA术后的CT数据，测量术后健侧和患侧的2D、3D前倾角和颈干角，髓内钉2D、3D前倾角。利用组内相关系数（intra-class correlation coefficient，ICC）检验股骨颈前倾角、颈干角等数据间的一致性，成对t检验比较成对数据的差异。结果：所建立测量方法的观察者间和观察者内信度均较高（ICC均大于0.9）。配对t检验显示不同髓内钉术后患侧前倾角与健侧前倾角相比差异均无统计学意义，一致性检验显示，患侧和健侧的2D、3D前倾角之间并无一致性（P分别为0.099和0.055）；但髓内钉2D、3D前倾角和患侧相应的2D、3D前倾角之间的一致性较好（总体ICC分别为0.81和0.8，P值均小于0.001）。PFNA组术后患侧前倾角与健侧的差值大于15°者占57%，明显高于InterTAN组的16%，配对t检验显示，PFNA术后的患侧和健侧的2D和3D颈干角之间差异无统计学意义（P值分别为0.925和0.367）， InterTAN术后患侧的2D和3D颈干角均明显小于健侧，差异有统计学意义（P值分别为0.033和0.009）。结论：通过对两种髓内钉术后股骨近端解剖形态的测量发现，与InterTAN相比，PFNA术后股骨颈前倾角变化较大，两种髓内钉的前倾角与术后患侧股骨颈前倾角均有较强的相关性。

关键词: 股骨骨折, 骨折固定术,髓内, 骨钉, 计算机辅助设计

Abstract: Objective： To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design (CAD) softwares, e.g. Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimensional (3D) anatomy. Intra-class correlation coefficient (ICC) was used to test the reliability of intra- and inter-observers. The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femoral nail anti-rotation (PFNA) were retrospectively analysed and used to measure bilateral proximal femoral anatomical parameters, including 2D and 3D femoral neck-shaft (NS) angle and femoral neck anteversion (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings. ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data. Results: The established measurement method hasdexcellent consistency within the intra- and inter-observers, with all the ICCs higher than 0.9. The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles. The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values < 0.001). In PFNA group, 57% of the differences between the 2D post-operative injured side’s and intact side’s NA angles were higher than 15°, which was more than 15.78% in InterTAN group. The paired student T-test showed no significant difference between the post-operative injured side’s 2D or 3D NS angles and the intact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively). Conclusion: By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group. There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.

Key words: Femoral fractures, Fracture fixation, intramedullary, Bone nails, Computer-aided design

中图分类号:

R683.42

赵晶鑫, 苏秀云, 赵喆, 张里程, 张立海, 唐佩福. 股骨近端髓内钉治疗股骨粗隆间骨折的影像学分析[J]. 北京大学学报（医学版）, 2015, 47(2): 263-268.

ZHAO Jing-Xin, SU Xiu-Yun, ZHAO Zhe, ZHANG Li-Cheng, ZHANG Li-Hai, TANG Pei-Fu. Radiographic analysis of treatment of inter-trochanteric fractures using proximal femoral nails[J]. Journal of Peking University(Health Sciences), 2015, 47(2): 263-268.

参考文献

相关文章 15

[1]	李怡,王丽瑜,刘晓强,周倜,吕季喆,谭建国. 不同材料及厚度椅旁CAD/CAM瓷贴面的边缘特征[J]. 北京大学学报（医学版）, 2022, 54(1): 140-145.
[2]	邱淑婷,朱玉佳,王时敏,王飞龙,叶红强,赵一姣,刘云松,王勇,周永胜. 姿势微笑位口唇对称参考平面的数字化构建及初步应用验证[J]. 北京大学学报（医学版）, 2022, 54(1): 193-199.
[3]	岳兆国,张海东,杨静文,侯建霞. 数字化评估CAD/CAM个性化基台与成品基台影响粘接剂残留的体外研究[J]. 北京大学学报（医学版）, 2021, 53(1): 69-75.
[4]	徐啸翔,曹烨,赵一姣,贾璐,谢秋菲. 数字化个齿托盘制取下颌全牙列全冠预备体印模的体外评价[J]. 北京大学学报（医学版）, 2021, 53(1): 54-61.
[5]	李峥,柳玉树,王时敏,张瑞,贾璐,叶红强,胡文杰,赵文艳,刘云松,周永胜. 数字化方法复制暂时修复体牙合面形态在重度磨耗病例中的应用[J]. 北京大学学报（医学版）, 2021, 53(1): 62-68.
[6]	房硕博,杨广聚,康艳凤,孙玉春,谢秋菲. 数字化辅助确定再定位牙合垫颌位方法的探索和精度评价[J]. 北京大学学报（医学版）, 2021, 53(1): 76-82.
[7]	罗佳,张宇,崔宏燕,祝宁,沈惠丹,邸萍,林野. 锥度固位结合数字化技术在后牙连续多牙种植即刻修复中的应用[J]. 北京大学学报（医学版）, 2020, 52(5): 964-970.
[8]	魏菱,邹东,陈虎,潘韶霞,孙玉春,周永胜. 一种数字化全口义齿的临床疗效评价[J]. 北京大学学报（医学版）, 2020, 52(4): 762-770.
[9]	孙玉春,王勇,邓珂慧,陈虎,李伟伟,赵一姣,潘韶霞,叶红强,周永胜. 功能易适数字化全口义齿的自主创新研发[J]. 北京大学学报（医学版）, 2020, 52(2): 390-394.
[10]	游浪,邓珂慧,李伟伟,赵一姣,孙玉春,周永胜. 无牙颌患者鼻唇角变化侧面观的视觉敏感阈值[J]. 北京大学学报（医学版）, 2020, 52(1): 107-112.
[11]	崔云鹏,米川,王冰,潘元星,林云飞,施学东. 股骨近端病理性骨折患者围手术期的临床特征分析[J]. 北京大学学报（医学版）, 2019, 51(5): 875-880.
[12]	陈硕,贺洋,安金刚,张益. 计算机辅助设计虚拟颌位在儿童颞下颌关节强直合并颌骨畸形同期矫治中的应用[J]. 北京大学学报（医学版）, 2019, 51(5): 954-958.
[13]	张祎然,饶烽,皮伟,张培训,姜保国. 股骨近端防旋髓内钉与动力髋螺钉治疗不稳定型粗隆间骨折的meta分析[J]. 北京大学学报（医学版）, 2019, 51(3): 493-500.
[14]	李欣欣,柳玉树,孙玉春,陈虎,叶红强,周永胜. 计算机辅助设计与制作一体化聚醚醚酮可摘局部义齿不同形态组件的适合性评价[J]. 北京大学学报（医学版）, 2019, 51(2): 335-339.
[15]	王冠博,叶红强,陈虎,王勇,孙玉春,周永胜. 无牙颌印模用个别托盘椅旁计算机辅助设计和三维打印系统建立与临床初步评价[J]. 北京大学学报（医学版）, 2019, 51(2): 349-355.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed