500例湖南地区股骨近端形态样本测量分析

目的: 了解性别、年龄对股骨髓腔形态的影响，以指导假体的选择和术中操作，提高假体的远期生存率。方法: 选取骨科及放射科各年龄段男、女性病例共500例。采集标准髋关节正位片，应用Onis 2.3软件进行测量，测量股骨近端外部形态参数、髓腔近端径线参数、近端髓腔形态参数共计13个参数，将数据输入SPSS V18.0软件进行分析。结果: 股骨近端相关参数与西方人种之间存在显著差异。与欧美人种相比，本组测得偏心距明显较小，而颈干角明显较大(P<0.05)，大多数股骨近端髓腔径线参数比欧美人种明显较小(P<0.05)。CFI明显较欧美人种大(P<0.01)，Noble分型香槟酒杯型所占比例明显较高，而正常型所占比例较低。31~50岁人群男女股骨近端形态相差最大(P<0.05); 0岁以上人群股骨近端形态差异最小(P>0.05)。31~70岁人群男女差异主要表现在股骨头直径、偏心距、峡部位置、峡部内外径以及小结节水平髓腔内径上(P<0.05)。男、女性小粗隆中点下方20 mm水平髓腔内径、峡部髓腔内径、峡部髓腔外径与年龄之间均呈正相关关系(均P<0.01)，而股骨近端髓腔形态参数与年龄存在负相关(均P<0.05)，而且女性股骨近端髓腔形态参数与年龄的相关程度更高。结论: 国人股骨近端相关参数与西方人种之间存在显著差异。男、女性，尤其是女性近端髓腔内径以及峡部内径随年龄增长均逐渐增宽而髓腔形态趋向变直。男女性股骨形态差异随年龄增长有减小的趋势，70岁以上人群男女股骨形态几乎没有差异，31~70岁男性股骨近端髓腔较女性宽而峡部位置较低。

Measurement of proximal femoral morphology and analysis of 500 cases in Hunan Province

Objective: To evaluate the effect of age and gender on the femoral morphology to guide prosthesis selection in operation and design.Methods: A total of 500 females and males were collected from the departments of orthopedics and medical radiology, Second Xiangya Hospital, Central South University. Informed consent was obtained from all subjects. All patients underwent anteroposterior position scan of the left or right hip joint using Philips Digital Diagnost DR system. The shooting range included the hip joint and at least 2/3 of the proximal femur. The images were measured with Onis 2.3 software. We measured 13 parameters from the patients, including the external paramters of the femur, radius-length parameters of femoral medullary cavity, and morphological parameters of the femoral medullary cavity.Results: Compared with Westeners, the offset was smaller, while the neck shaft angle was significantly larger in Chinese population (P<0.05). Most parameters of the proximal femoral medullary cavity diameter were significantly smaller in Chinese population than those in Westerners (P<0.05). The canal flare index in Chinese population was significantly larger than that in the Westerners (P<0.01). According to the Noble classification, in Chinese population, the proportion of champagne flute type was significantly larger, while the proportion of standard type was significantly smaller than that in Westerners. There was significant difference in the proximal femur between Chinese population and Westerners. The largest difference of the proximal morphology was presented between males and females in the 31–50 years old people (P<0.05), while the smallest was in the over 70 years old population (P>0.05). The main differences between 31 and70 years old were the diameter of femoral head, the offset of isthmus, the medullary cavity diameter and extracortical width at isthmus level and the medullary cavity diameter at the level of the lesser trochanter (P<0.05). The modullary transverse diameter at 20 mm below the lesser trochanter and isthmus and extracortical width of isthmus in the male and female group was positively correlated with age (P<0.01), while the parameters of the proximal femoral canal morphology in the female group were negatively correlated with age. The female canal parameters had a stronger correlation.Conclusion: Chinese proximal femoral parameters are significantly different from Westerners. When people, especially females, get older, the medullary cavity diameter of the isthmus and proximal femur becomes wider and the morphology of the femur becomes straight. The difference in the femoral morphology between the male and female decline with the age. There is almost no difference for the over 70 years old. For the 31–70 years old, The male femoral cavity diameter is larger and the position of isthmus is lower than in the females.