股骨近段CT扫描与全髋关节置换的术前计划

背景：做好全髋关节置换前假体型号预测的前提是对股骨近段的充分了解和精确测量,但X射线片仅提供一个平面图像,不能了解股骨近段横断面的情况,而股骨上段CT扫描可以提供更多信息。目的：观察股骨近段CT扫描在全髋关节置换前计划中的作用。方法：对61例进行初次全髋关节置换的患者行股骨近端CT扫描,选取股骨小转子最突出处上方2 cm股骨颈平面(T20)、股骨小转子最突出点处的股骨转子区平面(T0)和股骨干髓腔最狭窄处平面(N)的横断面CT影像。测量股骨颈平面髓腔长径、宽径、内侧径;小转子平面髓腔长径、内侧径;股骨峡部平面髓腔长径、宽径、皮质厚度。结果与结论：股骨颈T20长径40.8~63.3 mm,平均(49.6±5.1) mm;T20宽径13.3~29.1 mm,平均(22.4±3.4) mm;T20内侧径7.2~14.6 mm,平均(10.6±1.6) mm。股骨转子区T0长径20.5~40.2 mm,平均(28.7±4.4) mm;T0内侧径4.3~13.0 mm,平均(8.1±1.7) mm。股骨峡部N长径8.2~22.4 mm,平均(14.1±3.1) mm;N宽径6.1~17.9 mm,平均(10.2±2.9) mm;N皮质厚度2.7~12.7 mm,平均(7.5±1.8) mm。提示股骨近端CT扫描可以提供更多的影像信息和更精确的测量数据,对全髋关节置换前计划有所帮助。

CT scan of proximal femur in preoperative plan of total hip arthroplasty

BACKGROUND:The premise of model prediction of prosthesis is the full understanding and accurate measurement on proximal femur before total hip arthroplasty, but X-ray film only can provides a ground-plan, cannot understand the cross-sectional of proximal femur. However, the CT scan of the proximal femur can provide more information.OBJECTIVE:To observe the effect of CT scan of proximal femur in the preoperative plan of total hip arthroplasty.METHODS:A total of 61 patients with primary total hip arthroplasty underwent CT scan of proximal femur. The parameters were defined from the CT films taken at T20 (the neck at 20 mm higher than the apex of lesser trochanter), T0 (the level of the apex of lesser trochanter), and N level (the level of femoral isthmus). The length-diameter, wide diameter, medial diameter of plane medullary cavity in neck of femur, the length-diameter, medial diameter of plane medullary cavity in lesser trochanter, the length-diameter, wide diameter, cortical thickness of plane medullary cavity in femoral isthmus was measured. RESULTS AND CONCLUSION: The length-diameter of the neck of femur at T20 level was 40.8-63.3, average (49.6±5.1) mm, wide diameter of the neck of femur at T20 level was 13.3-29.1, average (22.4±3.4) mm and medial diameter of the neck of femur at T20 level was 7.2-14.6, average (10.6±1.6) mm; the length-diameter of the intertrochanter region at T0 level was 20.5-40.2 mm, average (28.7±4.4) mm, medial diameter of intertrochanter region at T0 level was 4.3-13.0, average (8.1±1.7) mm; the length-diameter of femoral isthmus at N level was 8.2-22.4, average (14.1±3.1) mm, wide diameter of femoral isthmus at N level was 6.1-17.9, average (10.2±2.9) mm and cortical thickness on wide diameter at N level was 2.7-12.7, average (7.5±1.8) mm. The CT scan of proximal femur can provide more image information and more accurate measured data, which is helpful to the preoperative plan of total hip arthroplasty.