中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (52): 9697-9701.doi: 10.3969/j.issn.1673-8225.2010.52.003

• 人工假体 artificial prosthesis • 上一篇    下一篇

股骨头/颈结合部形态三维CT图像测量在髋关节表面置换中的意义

叶庭均,冯建民   

  1. 上海交通大学医学院附属瑞金医院骨科,上海市   200025
  • 出版日期:2010-12-24 发布日期:2010-12-24
  • 通讯作者: 冯建民,主任医师,上海交通大学附属瑞金医院骨科,上海市 200025 fengjm_cn@yahoo.com
  • 作者简介:叶庭均★,男,1981年生,江苏省无锡市人,汉族,2006年上海交通大学医学院毕业,硕士,医师,主要从事人工关节方向研究。 stevesyndrome@hotmail.com

Three-dimensional CT morphologic measurement of femoral head/neck junction in hip surface replacement

Ye Ting-jun, Feng Jian-min   

  1. Department of Orthopeadics, Shanghai Ruijin Hospital of Shanghai Jiao Tong University Medical School, Shanghai  200025, China
  • Online:2010-12-24 Published:2010-12-24
  • Contact: Feng Jian-min, Chief physician, Department of Orthopeadics, Shanghai Ruijin Hospital of Shanghai Jiao Tong University Medical School, Shanghai 200025, China fengjm_cn@yahoo.com
  • About author:Ye Ting-jun★, Master, Physician, Department of Orthopeadics, Shanghai Ruijin Hospital of Shanghai Jiao Tong University Medical School, Shanghai 200025, China stevesyndrome@hotmail.com

摘要:

背景:髋关节表面置换保留了股骨头/颈结合部结构,因此存在股骨头/颈结合部切迹的风险,可能进一步导致术后股骨颈骨折。
目的:分析与髋关节表面置换相关的股骨头/颈结合部形态。
方法:共102例健康髋关节三维CT图像,根据实验设计获取截面图像,该截面与股骨干长轴成50°(或45°,55°)夹角,与股骨颈长轴垂直,定位于股骨头/颈结合部。测量该截面内-外径长度,前-后径长度,在截面图像上作圆,要求该圆包容股骨头/颈结合部截面骨皮质,并作到最小,取得圆心,在该圆的外侧半圆内(股骨颈外上方)找到骨皮质最突起的部位,连接圆心作半径线,测量并统计该线与水平线之间的夹角(α角)。统计分析内-外径长度、前-后径长度,α角的大小以及影响因素。
结果与结论:内-外径长度明显大于前-后径长度,男性大于女性,α角平均约27°,与身高体质量性别均无关。结果提示,髋关节表面置换术中股骨颈外上方和内下方造成切迹的可能性较大,其中可能性最大的部位是股骨头/颈结合部“外上前方”,与水平线夹角约27°,在术中需特别加以注意和保护。

关键词: 髋关节表面置换, 头颈结合部截面, 内-外径, 前-后径, 三维

Abstract:

BACKGROUND: The femoral head/neck junction is preserved in hip resurfacing, so femoral head/neck junction could be at great risk of notching, leading to postoperative femoral neck fracture.
OBJECTIVE: To analyze the contour of femoral head/neck junction in hip resurfacing surgery.
METHODS: Three dimensional CT images were collected from 102 healthy hips. The very cross section which was perpendicular to the long axis of femoral neck was obtained to make an angle of 50° (or 45°, 55°) with femoral shaft through the femoral head/neck junction. The medial-lateral length (a) and anterior-posterior length (b) were measured. A best-fit circle was created to the outer cortex of the section, and a point (point A) most close to the circle at the lateral part of cortex was identified. A line from point A to the circle centre was created to measure the angle (angle α) made of this line and the horizontal line. The medial-lateral length (a) and anterior-posterior length (b) was compared. The angle α and influencing factors were calculated.
RESULTS AND CONCLUSION: Medial-lateral length (a) was significantly greater than anterior-posterior length (b), and male was > female. The mean angle α was 27°. There were no correlation between the angle α and length, body mass or gender. Notching is more possible to occur at superior-lateral or inferior-medial side, and is most possible to occur at “superior-lateral-anterior” part. Point A is 27°anterior to the horizontal line. Surgeons should pay much attention to protect it.

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