CAJ | 학술논문

目的测量移位型股骨颈骨折股骨头的空间移位程度并进行三维重建,为临床评估移位型股骨颈骨折严重程度及判断预后提供依据. 方法收集80例移位型股骨颈骨折患者(GardenⅢ型40例,GardenⅣ型40例)双侧股骨近端多层螺旋CT薄层扫描数据(DICOM格式),导入三维重建软件生成双侧股骨近端三维模型.通过软件的三维测量技术计算股骨头空间移位参数,并进行数据整理和分析. 结果 GardenⅢ型、Ⅳ型股骨头小凹最深点的移位分别为(23.7±10.0)mm和(30.2±9.0) mm(P＜ 0.05);GardenⅢ型、Ⅳ型股骨头中心的移位分别为(14.4 ±5.6)mm和(18.8 ±5.5)mm(P ＜0.05);GardenⅢ型、Ⅳ型股骨头空间位移的角度分别为(29.2±15.7).和(39.1±17.1).(P＜0.05).GardenⅣ型组中13％ (5/40)为粉碎性骨折,而GardenⅢ型组无粉碎性骨折. 结论三维重建能更全面、准确地评价股骨颈骨折类型及移位程度.目前使用较为广泛的Garden分型对于移位型股骨颈骨折的认识存在一定局限性,临床医师需重新认识并制订更适宜的诊疗方案.
목적 측량이위형고골경골절고골두적공간이위정도병진행삼유중건,위림상평고이위형고골경골절엄중정도급판단예후제공의거. 방법 수집80례이위형고골경골절환자(GardenⅢ형40례,GardenⅣ형40례)쌍측고골근단다층라선CT박층소묘수거(DICOM격식),도입삼유중건연건생성쌍측고골근단삼유모형.통과연건적삼유측량기술계산고골두공간이위삼수,병진행수거정리화분석. 결과 GardenⅢ형、Ⅳ형고골두소요최심점적이위분별위(23.7±10.0)mm화(30.2±9.0) mm(P＜ 0.05);GardenⅢ형、Ⅳ형고골두중심적이위분별위(14.4 ±5.6)mm화(18.8 ±5.5)mm(P ＜0.05);GardenⅢ형、Ⅳ형고골두공간위이적각도분별위(29.2±15.7).화(39.1±17.1).(P＜0.05).GardenⅣ형조중13％ (5/40)위분쇄성골절,이GardenⅢ형조무분쇄성골절. 결론 삼유중건능경전면、준학지평개고골경골절류형급이위정도.목전사용교위엄범적Garden분형대우이위형고골경골절적인식존재일정국한성,림상의사수중신인식병제정경괄의적진료방안.
Objective To measure the displacement of the femoral head via three-dimensional reconstruction so as to re-understand the displaced femoral neck fracture.Methods Eighty patients with displaced femoral neck fracture were included in the study including 40 with Garden type Ⅲ and 40 with Garden type Ⅳ fractures.Spiral CT of bilateral proximal femurs was performed along with threedimensional reconstruction.Displacement parameters of femoral head were determined with threedimensional measurement technology.Results In cases of Garden type Ⅲ and Ⅳ fractures,displacement of the deepest point of fovea capitis of the femoral head was (23.7 ± 10.0) mm and (30.2 ± 9.0)mm(P ＜ 0.05) ; displacement of femoral head center was (14.4 ± 5.6)mm and (18.8 ± 5.5) mm (P ＜ 0.05) ; femoral head displacement angle was (29.2 ± 15.7) ° and (39.1 ± 17.1) ° (P ＜ 0.05).The incidence of the comminuted fracture was 13％ (5/40) among the patients with Garden type Ⅳ fracture.In comparison,no comminuted fracture occurred among the cases of Garden type Ⅲ fracture.Conclusions Three-dimensional reconstruction and digital measurement are precise and efficient methods for the measurement of fracture type and displacement in patients with femoral neck fracture.The present Garden classification for femoral neck fracture has certain defects and limitations.The clinicians should re-understand the displaced femoral neck fracture and choose more reasonable treatment.