股骨颈内固定螺钉构型的解剖影像分析

目的 根据影像解剖图像分析探讨股骨颈骨折3枚螺钉内固定的最优螺钉构型。方法 自2017年1月至2月，在安吉县人民医院医学影像信息系统（PACS）中回顾性选择15例正常成人双侧(30根)股骨行三维CT重建，其中男8例，女7例；年龄28～63岁，平均(43±8.5)岁。于股骨颈中心轴线垂直方向在颈中部显示股骨颈截面（FNS)，经图像重叠获得其在股骨转子外侧壁的投影。在股骨颈截面内模拟3种螺钉构型：以股骨颈截面长轴为中线的等边三角形构型（IET-FNS组）、股骨冠状轴为中线的等边三角形构型（IET-PF组）和股骨颈截面内的钝角三角形螺钉构型（OT组）。观察螺钉间距离、螺钉距股骨颈截面中心距离、螺钉工作面积与股骨颈截面积比。结果 螺钉间的距离：OT组（5.96±0.37）cm；IET-FNS组（4.74±0.39）cm。IET-PF组（4.58±0.39）cm；螺钉与股骨颈截面中心点距离：OT组（3.43±0.18）cm；IET-FNS组（2.81±0.17）cm；IET-PF组（2.72±0.14）cm。螺钉面积与股骨颈截面积比：OT组（0.31±0.01）；IET-FNS组（0.21±0.02）；IET-PF组（0.16±0.01）。OT组3项测量指标值均较大于其他两组，差异有统计学意义（P＜0.05）。结论 从影像解剖学分析，钝角三角形螺钉构型在观察指标螺钉间距离，螺钉距股骨颈截面中心距离、螺钉工作面积与股骨颈截面积比有优势，可能是股骨颈骨折3枚螺钉内固定的理想构型，但需要进一步的生物力学测试证实。

Anatomical imaging analysis of screw configuration for femoral neck fracture#br#

Objective To investigate the optimal screw configuration for internal fixation of femoral neck fractures based on anatomic analysis on radiologic imaging.Methods From January to February 2017, thirty proximal femurs of 15 normal adults from Picture Archiving and Communication Systems（PACS） of Paople’s Hospibal of Anji were constructed by CT. 8 males and 7 females with a mean age of (43±8.5) years (ranging from 28 to 63 years).The medial femoral neck sections (FNS) were projected on the lateral femoral trochanteric wall. The simulated three screw configurations in the projection of FNS include: two inverted equilateral triangles symmetrized to the axis of the FNS (IET-FNS group) or the coronal axis of the proximal femur (IET-PF group) and an obtuse triangle (OT group).The distance between the screws, the distance between the centre of the FNS and the screws, and the area ratio of the triangle/FNS were calculated.Results The projection of the FNS on the lateral femoral trochanteric wall was displayed as a rotating forward ellipse. Measurements of distance between screws：OT group（5.96±0.37）cm；IET-FNS group（4.74±0.39）cm；IET-PF group（4.58±0.39）cm. Distance between the centre of the FNS to the screws：OT group（3.43±0.18）cm；IET-FNS group（2.81±0.17）cm；IET-PF group（2.72±0.14）cm. And the area ratio of triangle/FNS OT group（0.31±0.01）；IET-FNS group（0.21±0.02）；IET-PF group（0.16±0.01） were significant larger in the OT group than in the IET-FNS and IET-PF groups (P<0.05). The values of the three parameters in the IET-FNS group were also larger than those in the IET-PF group (P<0.05). Conclusion The obtuse triangle screw configuration displays advantages with respect to the parameters of distance between screws, distance between the centre of FNS to screws, and the triangle area. Therefore, the obtuse triangle screw configuration may be the ideal pattern for internal fixation of femoral neck fractures. This needs to be corroborated with biomechanics testing.