股骨近端髓腔三维解剖测量

目的测量国人股骨近端髓腔形态,探讨适合国人的股骨近端髓内钉设计方案。方法选取120侧(男性55侧,女性65侧)正常成人单侧股骨近端CT扫描数据,利用Mimics图像分析软件对股骨近端的髓腔内径及髓腔开大指数行三维解剖测量,研究其与身高、年龄之相关性,及性别差异,并与国内外数据进行综合比较。结果以小粗隆中点为参考点(T),男、女性组髓腔内径分别为:T+20(44.79±5.42)mm和(39.79±4.96)mm;T+10(34.00±3.64)mm和(32.06±3.29)mm;T(26.93±3.71)mm和(24.18±3.31)mm;T-20((18.65±2.96)mm和(18.21±2.60)mm;峡部(10.40±1.45)mm和(10.15±1.05)mm。男女组T+20、T+10、T处比较存在显著性差异(P0.001);T-20、峡部处两组间比较无显著性差异(P0.05)。身高与各组间数据存在正相关关系,存在统计学意义(P0.05),与干骺端髓腔开大指数呈负相关,存在统计学意义(P0.05);偏相关分析年龄与髓腔内径参数间存在正相关关系,存在统计学意义(P0.05),而与各组髓腔开大指数间无明显相关性。结论东西方人、男女性之间股骨近端髓腔内径存在显著性差异,在治疗粗隆间骨折时需要充分评估其股骨近端内径,选用合适的内固定器械。

The measurement of three-dimensional anatomy of the proximal femoral medullary cavity

Objectives　To study the morphologic features of the proximal femoral medullary cavity, and provide basis for the design and application of the domestic proximal femoral nail(PFNA).    Methods　The CT image data of 120 Chinese proximal femurs（male 55 cases， female 65 cases）were collected in this study. Three-dimensional anatomic parameters, including internal diameter of medullary cavity, and the canal flare index of the proximal femurs, were analyzed adopting mimics software, while, the correlations of the above parameters with the age, the height and the gender of patients were analyzed statistically.  Results　 Using the mid-point of lesser trochanter as a reference，the internal diameter of medullary cavity were  T+20(44.79±5.42)mm and (39.79±4.96) mm；T+10(34.00±3.64) mm and (32.06±3.29) mm；T(26.93±3.71)mm and (24.18±3.31) mm；T-20（(18.65±2.96) mm and (18.21±2.60) mm for male and female respectively, as well as of the isthmic portion (10.40±1.45)mm and  (10.15±1.05) mm respectively. There were significant difference of the above parameters between both sexes in T+20, T+10 and T states (P<0.05), on the contrary, no significance appeared in T-20 and isthmus states. All data were positively correlated with patients' height except for MCFI, which was negative correlated with the height. The internal diameter of the medullary cavity were positively correlated with patients' age (P<0.05), however, there were no correlation between the age and CFI, MCFI and DCFI. Conclusions　The anatomic parameters of medullary cavity are variable for both sexes and different races, which implicates that, it is important to select the suitable fixation devices for treating different intertrochanteric fracture.