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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2024年01期

页码:

4-9

栏目:

股骨骨折

出版日期:

2024-02-05

文章信息/Info

Title:

Three-dimensional imaging characteristics of cortical support reduction aftercephalomedullary nailing in intertrochanteric hip fractures

作者:

杜守超1; 王欣2; 张世民1; 胡孙君1; 熊文峰1; 李波1

200090 上海市，同济大学附属杨浦医院骨科1；200065 上海市，同济大学附属同济医院骨科2

Author(s):

Du Shouchao1;  Wang Xin2;  Zhang Shimin1;  Hu Sunjun1;  Xiong Wenfeng1;  Li Bo1

1Departmentof Orthopedics, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China; 2Departmentof Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China

关键词:

皮质支撑复位;  内侧皮质;  前侧皮质;  前内侧角

Keywords:

Cortical support reduction;  Medial cortex;  Anterior cortex;  Anteromedial angle

DOI:

10.3877/cma.j.issn.2096-0263.2024.01.002

文献标志码:

A

摘要:

目的 探讨股骨转子间骨折头髓钉术后皮质支撑砥住的形态特征，为皮质支撑复位理论提供参考依据。方法 回顾分析2020年1月至2022年6月，在本院采用头髓钉治疗的顺向股骨转子间骨折患者，收集术后3D-CT影像学资料完整、获得皮质支撑砥住的病例共72例，男25例，女47例；年龄65～99岁，平均82.8岁。术前根据2007年AO/OTA分型：31-A1型21例，31-A2型51例。术后3D-CT观察头颈骨块与股骨干骨块的皮质接触形态，将其分为3种：①头颈尖齿vs.内侧皮质；②头颈尖齿vs.前内侧角；③前侧皮质vs.前侧皮质。在T3DView软件上观察头颈骨块旋转类型：无旋转、屈曲位旋转和过伸位旋转，并测量旋转角度。结果 皮质支撑形态尖齿vs.内侧皮质、尖齿vs.前内侧角和前侧皮质vs.前侧皮质例数分别为14例、51例和7例，占比分别为19.5%、70.8%和9.7%。三种不同皮质支撑形态的头颈骨块旋转类型不同（c2=20.850，P＜0.01）。头颈骨块旋转在三种类型中最常见的形态均为屈曲位旋转，共57例（占比79.2%），旋转角度分别为（13.1±5.3）°、（15.0±5.2）°和（18.5±8.8）°，方差分析F=1.073（P＞0.05），表明3种形态屈曲位旋转角度无差异。结论 股骨转子间骨折皮质支撑复位绝大多数为功能复位，最常见的形态特征是头颈骨块尖齿向前屈曲位旋转，与股骨干的前内侧角接触砥住。

Abstract:

Objective To investigate the morphological characteristics of cortical support reduction cephalomedullary nailing in intertrochanteric hip fractures, and to provide a reference for further study of cortical buttress reduction theory. Methods From January 2020 to June 2022, aretrospective study was conducted on 72 patients treated with short femoral cephalomedullary nails for intertrochanteric fracturesin our hospital, including 25 males and 47 females, who had complete 3D-CT imaging data and obtained cortical supportreduction. The average age is 82.8 years old, ranging from 65 to 99 years old. According to the AO/OTA classification in 2007, 21 cases were of type 31-A1 and 51 cases were of type 31-A2. The cortical contact morphology between the head-neck fragment and the proximalfemoral shaft was observed by 3D-CT after operation, and it was divided into three types: the cuspof head-neck fragmentvs. the medial cortex of proximalfemoral shaft, the cuspvs. The anteromedial angle, and the anterior cortex vs. the anterior cortex. Through the postoperative 3D-CT rotation stereoscopic observation, the rotation ofhead-neck fragmentsare divided into three types: no rotation, flexion rotation and hyperextension rotation, and measure the rotation angles. Results There were 14 cases of cusp vs. medial cortex, 51 cases of cusp vs. anteromedial angle and 7 cases of anterior cortex vs. anterior cortex in cortical supportreduction, accounting for 19.5%, 70.8% and 9.7% respectively. Chi square test was performed for three types, c2=20.850 (P<0.01). It showed that the rotation types of head-neck fragmentwere different from the morphology of cortical support.The most common shape of head-neck fragment rotation in the three types was flexion rotation, with 57 cases (79.2%) in total. The rotation angles were (13.1±5.3) °, (15.0±5.2) ° and (18.5±8.8) °, respectively. ANOVA F=1.073 (P>0.05), indicating that the rotation angles of the three types of flexion positions were the same. Conclusions Cortical support reduction of intertrochanteric fractureis mostly functional reduction. The common morphological feature is that the cusp of head-neck fragment is in the forward flexion position and contacts with the anteromedial angle of the femoral shaft.

备注/Memo

备注/Memo:

基金项目：国家自然科学基金面上项目（81772323）

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更新日期/Last Update: 2024-08-01