目的 再次探讨股骨上端张力性骨小梁和“Ward 三角”的形态特点，为股骨颈骨折的发病机制及治疗提供解剖学依据。 方法 股骨标本40具（正常组20具，骨质疏松组20具），分别沿股骨颈轴向切面、冠状面、横断面、矢状面切开，观察正常组和骨质疏松组张力性骨小梁、股骨颈皮质和“Ward 三角”的形态特点。 结果 一部分张力性骨小梁起自股骨头软骨下骨，呈弧形走行与股骨颈前上骨皮质融为一体，另一部分起始于股骨颈皮质，连接到大转子、基底部和股骨外侧骨皮质；正常组张力性骨小梁密集，股骨颈前内侧皮质致密，其厚度为（1.64±0.06）mm，骨质疏松组张力性骨小梁稀疏，骨皮质疏松，厚度为（1.20±0.04）mm，差异具有显著性；股骨上端轴向切面和冠状切面下“Ward 三角”呈菱形，正常组其内骨小梁密实，骨质疏松组的“Ward 三角”区大，其内骨小梁稀疏；股骨颈前倾角[正常组（13.78±1.92）°，骨质疏松组（8.78±1.07）°]，差异有统计学意义。 结论 股骨颈前上方骨皮质与附着于内面的骨小梁共同组成了股骨上端张力性系统，骨质疏松组该系统的骨小梁及骨皮质均出现稀疏，骨皮质变薄，Ward 菱形区变大，可能是骨质疏松时股骨颈骨折的解剖学因素之一，保护张力性骨小梁是预防股骨颈骨折的关键。
Abstract
Objective To further explore the morphological characteristics of tension bone trabeculae at the upper end of femur and "Ward triangle", so as to provide anatomical evidence for the pathogenesis and treatment of femoral neck fractures. Methods Forty femoral specimens (20 in normal group and 20 in osteoporosis group) were cut along the axial, coronal, cross-sectional, and sagittal planes of femoral neck respectively to observe the morphological characteristics of tension bone trabeculae, the cortex of femoral neck and "Ward triangle" in normal group and osteoporosis group. Results Some tension bone trabeculae originated from the subchondral bone on femoral head, ran in an arc forward, and merged with anterosuperior cortical bone of femoral neck. Another part of tension bone trabeculae originated from the cortical bone of femoral neck and connected to greater trochanter, the base of femoral neck, and the inner surface of the lateral cortical bone at the upper end of femur. In normal group, tension bone trabeculae were dense, and the anteromedial cortex of femoral neck was dense, with a thickness of (1.64±0.06) mm. In osteoporosis group, tension bone trabeculae were sparse, and the anteromedial cortex of femoral neck was loose, with a thickness of (1.20±0.04) mm (P<0.05). On the axial and coronal section of the upper end of femur, "Ward triangle" was shown in a rhombus shape. In normal group, the internal trabeculae were dense, while in osteoporosis group, "Ward triangle" area was large, with sparse trabeculae. The anteversion angle in osteoporosis group (8.78±1.07)° was significantly lower than that in normal group (13.78±1.92)°. Conclusions The anterosuperior cortical bone of femoral neck and the trabeculae attached to the inner surface together form tensile system at the upper end of femur. In osteoporosis group, both the trabeculae and cortical bone of this system become sparse, the cortical bone becomes thinner, Ward rhombic area becomes larger. This may be one of the anatomical factors for femoral neck fractures in osteoporosis. Protecting tension bone trabeculae is the key to preventing femoral neck fractures.
关键词
张力性骨小梁 /
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骨皮质 /
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Ward 三角 /
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骨质疏松 /
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股骨颈骨折
Key words
Tension bone trabeculae /
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Bone cortex /
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Ward triangle /
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Osteoporosis /
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Femoral neck fracture
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参考文献
[1] Ding K, Zhu Y, Li J, et al. Age-related Changes with the Trabecular Bone of Ward's Triangle and Neck-shaft Angle in the Proximal Femur: A Radiographic Study[J]. Orthop Surg, 2023, 15(12): 3279-3287. DOI: 10.1111/os.13923.
[2] Ward FO. Outlines of human osteology[M]. London: Henry Renshaw,1838:370.
[3] 叶丹丹, 朱燕宾, 陈伟, 等. 股骨头、颈及转子间骨小梁三角的研究[J]. 河北医科大学学报, 2021, 42(9):1093-1096. DOI: 10.3969/j.issn.11007-3205.2021.09.020.
Ye DD, Zhu YB, Chen W, et al. Study on the trabecular triangle of the femoral head, neck and intertrochanter[J]. Journal of Hebei Medical University, 42(9), 1093-1096. DOI: 10.3969/j.issn.11007-3205.2021. 09.020.
[4] 崔志刚，杜心如，孔祥玉. 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[J]. 中国临床解剖学杂志, 2016, 34(5): 504-508. DOI: 10.13418/j.issn.1001-165x.2016.05.006.
Cui ZG, Du XR, Kong XY. Radiological anatomy of the structural weak region in the femoral neck in the osteoporosis and its clinical significance[J]. Chin J Clin Anat, 2016, 34(5):504-508. DOI: 10.13418/j.issn.1001-165x.2016.05.006.
[5] 李海艳, 黎萌, 杜心如. 股骨头颈压力骨小梁与股骨颈后内侧骨皮质及股骨距移行处的形态学观察及临床意义[J]. 中国临床解剖学杂志, 2025, 43(1):1-8. DOI: 10.13418/j.issn.1001-165x.2025.1.01.
Li HY, Li M, Du XR. Morphological observation and clinical significance of pressure bone trabeculae of femoral head and neck, posteromedial bone cortex of femoral neck and femoral calcar[J]. Chin J Clin Anat, 2025, 43(1):1-8. DOI: 10.13418/j.issn.1001-165x.2025.1.01.
[6] Soontrapa S, Soontrapa S. Modified Singh index in diagnosing femoral neck osteoporosis[J]. J Med Assoc Thai. 2011, 94 Suppl 5:S79-83.
[7] 孙蕴, 贺丽英, 马兆坤, 等. Ward三角区再研究[J]. 中国骨质疏松杂志, 2016, 22(6):706-710,717. DOI: 10.3969/j.issn.1006-7108. 2016. 06.010.
Sun Y, He LY, Ma ZK, et al. Further study on the Ward's triangle region[J]. Chin J Osteoporos, 2016, 22(6):706-710,717. DOI: 10.3969/j.issn.1006-7108.2016.06.010.
[8] Lv H, Chen W, Zhang T, et al. Traumatic fractures in China from 2012 to 2014: a National Survey of 512,187 individuals[J]. Osteoporos Int, 2020,31(11):2167-2178. DOI: 10.1007/s00198-020-05496-9.
[9] Ding K, Yang W, Zhu J, et al. Titanium alloy cannulated screws and biodegradable magnesium alloy bionic cannulated screws for treatment of femoral neck fractures: a finite element analysis[J]. J Orthop Surg Res, 2021, 16(1):511. DOI: 10.1186/s13018-021-02665-2.
[10]Davis E, LeBrun DG, McCarthy T, et al. Femoral Neck Anteversion: Which Distal Femur Landmark Matters[J]? Arthroplast Today, 2024, 26:101318. DOI: 10.1016/j.artd.2024.101318.
[11] 续开亮, 孟昊业, 汪爱媛, 等. 骨质疏松头颈型股骨颈骨折股骨头的显微CT观察[J].实用骨科杂志, 2024, 30(8):706-710. DOI: 10.3760/cma.j.issn.1008-5572.2024.08.107.
Xu KL, Meng HY, Wang AY, et al. Miro-CT observation of trabecular bone of femoral head in osteoporotic femoral neck fracture[J]. J Prac Orthop, 2024, 30(8):706-710. DOI: 10.3760/cma.j.issn.1008-5572.2024.08.107.
[12] Scorcelletti M, Reeves ND, Rittweger J, et al. Femoral anteversion: significance and measurement[J]. J Anat, 2020, 237(5):811-826. DOI: 10.1111/joa.13249.
基金
承德医学院高层次人才科研启动基金（202203）；承德医学院人体解剖与组织胚胎学优势学科资助项目（202302）
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