骨质疏松时股骨颈结构薄弱区影像解剖学观察及其临床意义
Radiological anatomy of the structural weak region in the femoral neck in the osteoporosis and its clinical significance
目的 探讨骨质疏松时股骨颈部位是否存在结构薄弱区。 方法 股骨颈 X片159例，观察由主压力、主张力与次压力骨小梁形成的斜“V”形结构薄弱区。 按Singh指数评估骨质疏松程度与结构薄弱区之间的关系。另收集10例股骨干燥标本按横断面、冠状面及矢状面观察内部骨小梁走行及薄弱区特点。 部分老年股骨颈骨折三维CT观察股骨颈内部骨小梁走行。 结果 Singh 1级（7 /159）， 无“V”形薄弱区；Singh 2级（23/159）,V形薄弱区34.78%； Singh 3级（42 /159）,“V”形薄弱区85.71%；Singh 4级（48 /159），“V”形薄弱区75%； Singh 5级（27 /159），“V”形薄弱区29.63%；Singh 6级（12 /159）,无薄弱区。横断面WARD三角底边为不连续主张力骨小梁；冠状面WARD三角形成斜向后外的“V”形薄弱区；矢状位WARD三角底边顶部在股骨颈滋养孔密集区，形成 “V”形薄弱区。股骨颈三维CT内部骨小梁走行与干燥骨剖面内部小梁走行一致。 结论 Singh 1、2级骨折倾向于头下型。 Singh 3、4级骨折倾向于头颈型。Singh 5、6级不易发生股骨颈骨折。
Objective The purpose of the study was to observe a structural weak region in the femoral neck in the osteoporosis. Methods 159 dry femur specimen were collected for this study for identification of the "V"-shaped weak region of trabeculae in the femoral neck. The degree of osteoporosis of the femoral neck specimens were classified according to the Singh index grading. The relationship between the Singh index grading and the "V"-shaped weak region of the neck was assessed. 10 femur neck samples were sectioned in transversal, coronal and sagittal plane for identifying the position of the trabeculae and the "V"-shaped weak region. Femoral neck three-dimensional CT reconstruction was used for identifying bone trabecular contorts. Results Singh index 1 (7/159), no of them have the "V"-shaped weak region; as Singh index 2 (23/159), 34.78% of them have the "V"-shaped weak region; as Singh index 3 (42/159), 85.71% of them have the "V"-shaped weak region; as Singh index 4 (48/159), 75% of them have the "V"-shaped weak region; as Singh index 5 (27/159), 29.63% of them have the "V"-shaped weak region. There was not the "V"-shaped weak region of the neck in the Singh index 6. The main pressure trabeculae, the main tension trabeculae, and the minor pressure trabecular bone consisted of WARD triangle in the coronal view, when the main tension trabecular disrupting or missing in osteoporosis, the "V" –shaped weak region is obvious. Conclusions Singh index 1-2 is prone to subcapital femoral neck fracture; In Singh index 3-4 tends to produce typical type of femoral neck fracture; In Singh index 5-6, femoral neck fracture is not easy to take place.
Femoral neck / Structural weak region / Radiological anatomy
[1] Bryan R, Nair P B, Taylor M. Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk[J]. J Biomech, 2009, 42(13):2171-2176.
[2] Wang Q, Teo J W, Ghasem-Zadeh A, et al. Women and men with hip fractures have a longer femoral neck moment arm and greater impact load in a sideways fall[J]. OsteoporosInt, 2009, 20(7):1151-1156.
[3] 王亦璁. 骨与关节损伤[M]. 第4版. 人民卫生出版社, 2011.
[4] 安永胜, 杜心如, 石友民, 等. 外斜位X线片显示股骨距影像特征及其临床意义[J]. 中国临床解剖学杂志, 2005, 23(4):393-395.
[5] Warriner A H, Patkar N M, Curtis J R, et al. Which fractures are most attributable to osteoporosis[J]. J ClinEpidemiol, 2011, 64(1):46-53.
[6] Stroup J, Kane MP, Abu-Baker AM. Teriparatide in the treatment of osteoporosis[J]. Am J Health Syst Pharm, 2008, 65(6):532-539.
[7] Allen MR, Hogan HA, Hobbs WA, et al. Raloxifene enhances material-level mechanical properties of femoral cortical and trabecular bone[J]. Endocrinology, 2007, 148(8):3908-3913.
[8] Benhamou CL. Effects of osteoporosis medications on bone quality[J]. Joint Bone Spine, 2007, 74(1):39-47.
[9] Iwamoto J, Takeda T, Ichimura S. Combined treatment with vitamin k2 and bisphosphonate in postmenopausal women with osteoporosis[J]. Yonsei Med J, 2003, 44(5):751-756.
[10] Has B, Nagy A, Has-Schon E, et al. Influence of instability and muscular weakness in ethiopathogenesis of hip fractures[J]. Coll Antropol, 2006, 30(4):823-827.
[11] 续开亮，杜心如. 股骨颈骨折解剖分型与骨质疏松严重程度关系的临床研究[J]. 中华解剖与临床杂志，2015, 20(4)：330-334.
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