股骨近端外侧壁的骨折特征地图研究

张英琪,张世民,熊文峰,马卓,杜守超,胡孙君

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (2) : 121-125.

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (2) : 121-125. DOI: 10.13418/j.issn.1001-165x.2017.02.001
应用解剖

股骨近端外侧壁的骨折特征地图研究

  • 张英琪1, 张世民2, 熊文峰2, 马卓2, 杜守超2, 胡孙君2
作者信息 +

Fracture mapping of proximal femoral lateral wall

  • ZHANG Ying-qi1,CHANG Shi-min2, XIONG Wen-feng2, MA Zhuo2, DU Shou-chao2, HU Sun-jun2
Author information +
文章历史 +

摘要

目的 通过骨折地图技术,明确股骨近端外侧壁的骨折特征,为临床及生物力学研究提供参考数据。   方法 采集96例股骨转子间骨折的CT数据,进行分割建模、虚拟复位。其中有56例发生外侧壁骨折,测量其外侧壁及骨折区宽度、高度、面积,骨折线走行等参数,并在3D重建模型上绘制骨折特征地图。  结果 96例患者中56例有外侧壁骨折,其中A2型71.4%(40例),外侧壁骨折块平均宽度(10.1±6.0)mm,高度(23.1±11.3)mm,面积(158.5±105.2)mm2,占外侧壁面积(12.1±8.1)%,骨折线与水平面成角(64.6±14.5)°;A3型28.6%(16例),外侧壁骨折块平均宽度(26.0±7.0)mm,高度(38.8±11.7)mm,面积(860.1±357.0)mm2,占外侧壁面积(64.5±25.9)%,骨折线与水平面成角(30.2±39.6)°。  结论 不同类型转子间骨折的外侧壁特征有明显差异,通过骨折地图技术可直观展现骨折信息,可为制作转子间骨折模型及临床治疗提供参考。

Abstract

Objective Using fracture map technology to study characteristics of the proximal femoral wall fracture, providing reference data for clinical and biomechanical studies. Method CT data from 96 patients with trochanteric fracture were collected. In the cases with proximal femoral lateral wall fracture, the lateral wall and fracture area (width, height, area, fracture line direction) were measured and fracture mapping was created. Result In 96 patients, 56 had lateral wall fractures. 71.4% were A2 type(40 cases). The average width of fractures area was (10.1±6.0) mm, the height was (23.1±11.3) mm, and the area was (158.5±105.2) mm2, accounting for (12.1±8.1)%. The fracture line was (64.6±14.5) ° with the horizontal plane. 28.6% were A3 type (16 cases). The average width of fracture area was (26.0±7.0) mm, height was (38.8±11.7) mm, and area was (860.1±357.0) mm2, accounting for (64.5±25.9)%. The angle of fracture line was (30.2± 39.6) °. Conclusion Characteristics of different types of trochanteric fractures of the lateral wall are significantly different. The fracture map can directly display fracture information. The results of this study can provide a reference for the standard fracture model in clinical and experimental study.

关键词

股骨转子间骨折 / 骨折地图 / 影像叠加 / 股骨近端外侧壁 / 转子外侧壁

Key words

Proximal femoral lateral wall / Lateral cortex / Trochanteric lateral wall / Fracture mapping / Trochanter fracture

引用本文

导出引用
张英琪,张世民,熊文峰,马卓,杜守超,胡孙君. 股骨近端外侧壁的骨折特征地图研究[J]. 中国临床解剖学杂志. 2017, 35(2): 121-125 https://doi.org/10.13418/j.issn.1001-165x.2017.02.001
ZHANG Ying-qi,CHANG Shi-min, XIONG Wen-feng, MA Zhuo, DU Shou-chao, HU Sun-jun. Fracture mapping of proximal femoral lateral wall[J]. Chinese Journal of Clinical Anatomy. 2017, 35(2): 121-125 https://doi.org/10.13418/j.issn.1001-165x.2017.02.001

参考文献

[1] Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography [J]. J Bone Joint Surg Am, 2009, 91(9): 2222-2228.
[2] Mellema JJ, Eygendaal D, van Dijk CN, et al. Fracture mapping of displaced partial articular fractures of the radial head [J]. J Shoulder Elbow Surg, 2016, 25(9): 1509-1516.
[3]  Cole PA, Mehrle RK, Bhandari M, et al. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures [J]. J Orthop Trauma, 2013, 27(7): e152-156.
[4]  Molenaars RJ, Mellema JJ, Doornberg JN, et al. Tibial Plateau Fracture Characteristics: Computed Tomography Mapping of Lateral, Medial, and Bicondylar Fractures [J]. J Bone Joint Surg Am, 2015, 97(18): 1512-1520.
[5]  张世民, 马卓, 杜守超, 等. 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.
[6]  张世民, 张英琪, 李清, 等. 内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响 [J]. 中国矫形外科杂志, 2014, 22(14): 1256-1261.
[7]  Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures [J]. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
[8]  Hu SJ, Chang SM, Ma Z, et al. PFNA-II protrusion over the greater trochanter in the Asian population used in proximal femoral fractures [J]. Indian J Orthop, 2016, 50(6): 641-646.
[9] Im GI, Shin YW, Song YJ. Potentially unstable intertrochanteric fractures [J]. J Orthop Trauma, 2005, 19(1): 5-9.
[10]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.
[11]Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures [J]. Clin Orthop Relat Res, 2004, 425(425): 82-86.
[12]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.
[13]Ma Z, Chang SM. Letter to the Editor: Where is the lateral femoral wall? [J]. Int Orthop, 2014, 38(12): 2645-2646.
[14]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.
[15]Lubberts B, Mellema JJ, Janssen SJ, et al. Fracture line distribution of olecranon fractures [J]. Arch Orthop Trauma Surg, 2017, 137(1): 37-42.
[16]Kerver AL, Carati L, Eilers PH, et al. An anatomical study of the ECRL and ECRB: feasibility of developing a preoperative test for evaluating the strength of the individual wrist extensors [J]. J Plast Reconstr Aesthet Surg, 2013, 66(4): 543-550.
[17] Kerver AL, van der Ham AC, Theeuwes HP, et al. The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation [J]. J Vasc Surg, 2012, 56(1): 181-188.
[18]Kerver AL, Leliveld MS, den Hartog D, et al. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery [J]. J Bone Joint Surg Am, 2013, 95(23): 2119-2125.
[19]Zhang YQ, Chang SM, Huang YG, et al. The femoral neck safe zone: a radiographic simulation study to prevent cortical perforation with multiple screw insertion [J]. J Orthop Trauma, 2015, 29(5): e178-182.
[20]Marmor M, Elliott IS, Marshall ST, et al. Biomechanical comparison of long, short, and extended-short nail construct for femoral intertrochanteric fractures [J]. Injury, 2015, 46(6): 963-969.
[21]Fensky F, Nuchtern JV, Kolb JP, et al. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures--a biomechanical cadaver study [J]. Injury, 2013, 44(6): 802-807.
[22]Krischak GD, Augat P, Beck A, et al. Biomechanical comparison of two side plate fixation techniques in an unstable intertrochanteric osteotomy model: Sliding Hip Screw and Percutaneous Compression Plate [J]. Clin Biomech, 2007, 22(10): 1112-1118.

基金

上海市科委医学引导类基金资助(14411971900)


Accesses

Citation

Detail

段落导航
相关文章

/