股骨大转子倾斜指数的概念提出与测量

目的提出股骨大转子倾斜指数的概念并探讨股骨大转子倾斜指数与旋转角度的规律，以判断股骨的旋转状态。 方法选取20名身体健康的成年志愿者，男l0名，女10名；年龄20～58岁，平均39.2岁；身高平均为167.1 cm(158～ 183 cm)。分别摄双腿处于中立位、内旋5°、10°、15°、20°，外旋5°、10°、15°、20°的X线片。然后测量并计算不同旋转状态下的股骨大转子倾斜指数。股骨大转子倾斜指数=大转子内侧壁至转子间嵴的最短距离/股骨干横径。 结果相同旋转角度下不同性别之间大转子倾斜指数差异无统计学意义(P＞0.05)。左、右侧大转子倾斜指数在相同旋转角度下比较差异均无统计学意义(P＞0.05)。股骨大转子倾斜指数在内旋20°、15°、10°、5°、中立位、外旋5°、10°、15°、20°时平均分别为0. 18±0.06、0.21 ±0.07、0.25±0.07、0.27±0.07、0.30±0.08、0.34±0. 09、0.38±0.09、0.42±0. 12、0.47±0. 12，差异有统计学意义（F=19. 737，P=0.000），旋转角度相差15°时两组股骨大转子倾斜指数比较差异均有统计学意义(P＜0.05)。股骨大转子倾斜指数与外旋角度的变化呈直线正相关。 结论股骨大转子倾斜指数随着股骨近端外旋角度的增加而增大，随着内旋而减小。通过测量股骨大转子倾斜指数可以判断股骨的旋转状态。

The concept of greater trochanter tilting index and its radiologic measurement in clinic

ObjectiveTo propose the concept of greater trochanter tilting index (GTTI) and to explore its association with femoral rotation.MethodsTwenty healthy adult volunteers were enrolled in the present study. They were 10 men and 10 women, aged from 20 to 58 years (average, 39.2 years). Their average height was 167. 1 cm (from 158 to 183 cm) . Posteroanterior radiographs of both of their proximal femurs were taken with their legs at the following positions: neutral position, internal rotations at 5°, 10°, 15° and 20°, external rotations at 5°, 10°, 15° and 20°. The GTTIs were measured and calculated at different rotation angles. The GTTI =the shortest distance between the intertrochanteric crest and the medial wall of greater trochanter / diameter of the femoral shaft. Statistical analyses were performed to explore GTTIs.ResultsThere were no significant differences between genders or between the left and right sides in GTTI at the same rotation angle ( P ＞ 0. 05). The average GTTIs at internal rotations at 20°, 15°, 10°, 5°, neutral position, external rotations at 5°, 10°, 15° and 20° were respectively 0. 18 ±0. 06, 0. 21 ±0. 07, 0. 25 ±0.07, 0.27±0.07, 0.30±0.08, 0.34±0.09, 0.38±0.09, 0.42±0.12, 0.47±0.12, significantly increasing with the increased external ration ( F =19. 737, P =0. 000) . The GTTIs were significantly different when their difference in rotation was greater than 15° ( P ＜ O. 05). There was a positive linear correlation between the GTTIs and external rotation angles.ConclusionSince the GTTIs increase with increased external rotation of the proximal femur and decrease with decreased internal rotation, they can be used to prevent malalignment during closed reduction.