髋部骨折的发生与股骨近端三维几何解剖形态的相关性研究

目的运用计算机辅助设计(computer aided design,CAD)及三维重建技术测量髋部几何解剖形态学参数,探究骨折人群股骨近端解剖形态与正常组人群(未骨折人群)的差异,分析其对髋部骨折发生率和发生类型的影响。方法通过髋部骨折患者正常侧下肢CT扫描图像,运用Mimics 10.01软件建立三维解剖形态模型,并测量股骨颈前倾角(femoral neck anteversion angle,FNAA)、颈干角(neck-shaft angle,NSA)、股骨头直径(femoral head diam-eter,FHD)及股骨颈轴长(length of femoral neck axis,LFNA)等正常股骨近端三维几何解剖形态学参数。结果股骨颈骨折组中FNAA、NSA、FHD、LFNA平均值为分别为(7.9±4.6)°、(128.6±4.6)°、(46.0±4.6)mm、(47.1±5.1)mm。股骨粗隆间骨折组中FNAA、NSA、FHD、LFNA平均值分别为(15.5±6.8)°、(134.7±6.9)°、(45.3±3.6)mm、(46.7±3.4)mm。股骨粗隆间骨折组FNAA及NSA无论男性还是女性都显著大于股骨颈骨折组(P<0.01),股骨颈骨折组、股骨粗隆间骨折组FNAA和NSA均与正常对照组有非常显著的差异性。结论中国人群FNAA较正常值大越容易发生股骨粗隆间骨折,较正常值小越容易发生股骨颈骨折。髋部骨折患者NSA较正常值大,其中NSA越大越容易发生股骨粗隆间骨折。骨折组人群的股骨近端解剖结构与正常人存在一定的差异,以角度解剖学参数影响为主。年龄越大越容易发生股骨粗隆间骨折,年龄越小越容易发生股骨颈骨折。

Correlation between the incidence of hip fractures and the proximal femur by 3D geometric anatomy

Objective To measure the hip anatomic parameters and explore the differences between the hip fracture group and the normal group, analyze their effect on the incidence of hip fractures and fracture types by using computer aided design (CAD) and three-dimensional reconstruction technique. Methods Through CT scan images from the lower-extremity of hip fracture patient, the 3D anatomic model was established by Mimics10.01 software, and the 3D anatomic parameters of the normal proximal femur, namely femoral neck anteversion angle (FNAA), neck-shaft angle (NSA), femoral head diameter (FHD), length of femoral neck axis (LFNA) in the lower-extremity were measured. Results The averages of FNAA, NSA, FHD, LFNA in femoral neck fracture group were (7.9±4.6)°, (128.6±4.6)°, (46.0±4.6) mm, (47.1±5.1) mm, and those parameters in intertrochanteric fracture group were (15.5±6.8)°, (134.7±6.9)°, (45.3±3.6) mm, (46.7±3.4) mm. The FNAA and NSA in intertrochanteric fracture group were significantly larger than those in femoral neck fracture group regardless of gender (P<0.01). The FNAA and NSA in both fracture groups showed significant differences as compared with the normal group. ConclusionsThe risk of femoral intertrochanteric fracture will increase when the FNAA is larger than the normal range in Chinese, while the risk of femoral neck fracture will increase when the FNAA is smaller than the normal range in Chinese. The NSA of hip fracture patients was larger as compared with normal Chinese. The larger NSA will lead to a higher risk of femoral intertrochanteric fracture. There exist some differences in anatomic parameters of the proximal femur between the fracture group and the normal group, especially in the angle parameter. The femoral intertrochanteric fractures are more prone to occur in the older people, while the femoral neck fractures are more prone to occur in the younger people.