股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义

张世民; 马卓; 杜守超; 胡孙君; 陶友伦

doi:10.13418/j.issn.1001-165x.2016.01.011

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (1) : 39-42. DOI: 10.13418/j.issn.1001-165x.2016.01.011

应用解剖

股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义

张世民，　马卓，　杜守超，　胡孙君，　陶友伦

作者信息 +

Anatomic study on the proximal femoral lateral wall and its clinical implications for geriatric intertrochanteric fractures

CHANG Shi-min， MA Zhuo， DU Shou-chao， HU Sun-jun， TAO You-lun

Author information +

文章历史 +

摘要

目的　研究观测股骨近端外侧壁的骨性与软组织解剖特征，为临床向股骨头内打入拉力螺钉或螺旋刀片的股骨外侧皮质提供参考数据。方法　采用16例成人股骨干燥标本、10例尸体下肢标本和20例老年股骨转子间骨折的横断面CT图像，分别测量外侧壁的骨性面积、软组织附着及其面积以及外侧壁骨皮质的厚度。结果骨性外侧壁平均高（24.4±2.4）mm，宽（23.3±2.0）mm，面积（567.0±82.8）mm2。臀中肌、臀小肌的止点与股外侧肌起点，在外侧壁处相互交织，形成致密坚韧的腱膜样重叠部，平均高（33.2±2.3）mm，宽（28.2±1.9）mm，厚（1.6±0.1）mm。老年人小转子平面的股骨外侧壁皮质薄弱，厚仅（2.3±0.5 ）mm。结论老年股骨转子间骨折的外侧壁皮质薄弱，容易骨折。推荐选用头髓钉系统进行内固定治疗，具有较高的安全性。

Abstract

Objective　Proximal femoral lateral wall is defined as the lateral cortex distal to the vastus insertion, which is the entry point to put lag screw/helical blade into femoral head for fixation of intertrochanteric fractures. This study was focused on the bony and soft-tissue of lateral wall anatomy, and aimed to provide reference data for clinical implications.　Method　Sixteen femurs, 10 lower limbs and 20 CT slices in geriatric pertrochanteric fractures were used to measure the bony area (height and width), soft-tissue attachment and intersection (height, width and thickness), and femur lateral cortical thickness at the mid lesser trochanteric level.　Result　The bony lateral wall has a mean height of (24.4±2.4) mm，width of (23.3±2.0) mm，and area of (567.0±82.8) mm2. The attachments of gluteus medius and minus terminal and the vastus origin were mixed and intersected with each other to form a tedious aponeurotic structure together. The soft-tissue lateral wall has a height of (33.2±2.3) mm，width of (28.2±1.9) mm，and thickness of (1.6±0.1) mm. The femoral lareral wall in geriatric patients was very thin, with a cortical thickness of (2.3±0.5) mm.　Conclusion　The lateral wall in geriatrics is very weak and vulnerable to fracture perioperatively. Cephalomedullary nail is superior to DHS for geriatric intertrochanteric fractures.

导出引用

张世民，马卓，　杜守超，　胡孙君，　陶友伦. 股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义[J]. 中国临床解剖学杂志. 2016, 34(1): 39-42 https://doi.org/10.13418/j.issn.1001-165x.2016.01.011

Anatomic study on the proximal femoral lateral wall and its clinical implications for geriatric intertrochanteric fractures[J]. Chinese Journal of Clinical Anatomy. 2016, 34(1): 39-42 https://doi.org/10.13418/j.issn.1001-165x.2016.01.011

参考文献

[1] Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures [J]. Clin Orthop Relat Res, 2004, (425):82-86.
[2] Im GI, Shin YW, Song YJ. Potentially unstable intertrochanteric fractures [J]. J Orthop Trauma, 2005, 19(1): 5-9.
[3] Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation [J]. J Bone Joint Surg Am, 2007, 89(3):470-475.
[4] Gotfried Y. Letter to the editor regarding “Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation” [J]. J Bone Joint Surg Am, 2007, 89(11): 2552-2253.
[5] 张世民. 股骨粗隆间骨折中外侧壁的概念及其临床意义[J]. 中国矫形外科杂志，2010，18(17)：1480-1483.
[6] 马卓，张世民. 股骨粗隆外侧壁研究进展[J]. 国际骨科学杂志，2012, 33(4)：221-224.
[7] Haq RU, Manhas V, Pankaj A, et al. Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial [J]. Int Orthop, 2014, 38(7):1443-1449.
[8] Ma Z, Chang SM. Where is the lateral femoral wall [J]?Int Orthop, 2014, 38(12):2645-2646.
[9] 张世民，祝晓忠，黄轶刚，等. 外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究[J]. 中国矫形外科杂志，2010，18(22):1868-1872.
[10] Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures [J]. Bone Joint J, 2013, 95-B(8):1134-1138.
[11] Hsu CE,Chiu YC, Tsai SH, et al. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls [J]. Injury, 2015, 46(6):1047-1053.
[12] Sharma G, Singh R, Gn KK, et al. Which AO/OTA 31-A2 pertrochanteric fractures canbe treated with dynamic hip screw without developing alateral wall fracture A CT-based study [J].IntOrthop, 2015 Jul 4. [Epub ahead of print]
[13] Boopalan PR, Oh JK, Kim TY, et al. Incidence and radiologic outcome of intraoperative lateral wall fractures in OTA 31A1 and A2 fractures treated with cephalomedullary nailing [J]. J Orthop Trauma, 2012, 26(11):638-642.
[14] Kim Y, Bahk WJ, Yoon YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochantericfractures [J]. Arch Orthop Trauma Surg, 2015 ,135(10):1349-1356.