北京大学学报（医学版）
北京大學學報（醫學版）
북경대학학보（의학판）
JOURNAL OF BEIJING MEDICAL UNIVERSITY(HEALTH SCIENCES)
2015年
2期
263-268
,共6页
赵晶鑫%苏秀云%赵喆%张里程%张立海%唐佩福
趙晶鑫%囌秀雲%趙喆%張裏程%張立海%唐珮福
조정흠%소수운%조철%장리정%장립해%당패복
股骨骨折%骨折固定术,髓内%骨钉%计算机辅助设计
股骨骨摺%骨摺固定術,髓內%骨釘%計算機輔助設計
고골골절%골절고정술,수내%골정%계산궤보조설계
Femoral fractures%Fracture fixation,intramedullary%Bone nails%Computer-aided design
目的：建立一种股骨近端三维解剖形态的测量方法，研究InterTAN髓内钉和股骨近端防旋髓内钉（ proxi-mal femoral nail anti-rotation，PFNA）手术对股骨近端解剖形态的影响。方法：利用Mimics等计算机辅助设计（ com-puter assisted design，CAD）软件，建立一种在三维条件下，测量股骨近端三维（3 dimensional，3D）解剖形态的方法，并完成信度实验。收集40例股骨粗隆间骨折患者行InterTAN和PFNA术后的CT数据，测量术后健侧和患侧的2D、3D前倾角和颈干角，髓内钉2D、3D前倾角。利用组内相关系数（intra-class correlation coefficient，ICC）检验股骨颈前倾角、颈干角等数据间的一致性，成对t检验比较成对数据的差异。结果：所建立测量方法的观察者间和观察者内信度均较高（ICC均大于0．9）。配对t检验显示不同髓内钉术后患侧前倾角与健侧前倾角相比差异均无统计学意义，一致性检验显示，患侧和健侧的2D、3D前倾角之间并无一致性（ P分别为0．099和0．055）；但髓内钉2D、3D前倾角和患侧相应的2D、3D前倾角之间的一致性较好（总体ICC分别为0．81和0．8，P值均小于0．001）。 PF-NA组术后患侧前倾角与健侧的差值大于15°者占57％，明显高于InterTAN组的16％，配对t检验显示，PFNA术后的患侧和健侧的2D和3D颈干角之间差异无统计学意义（P值分别为0．925和0．367）， InterTAN术后患侧的2D和3D颈干角均明显小于健侧，差异有统计学意义（ P值分别为0．033和0．009）。结论：通过对两种髓内钉术后股骨近端解剖形态的测量发现，与InterTAN相比，PFNA术后股骨颈前倾角变化较大，两种髓内钉的前倾角与术后患侧股骨颈前倾角均有较强的相关性。
目的：建立一種股骨近耑三維解剖形態的測量方法，研究InterTAN髓內釘和股骨近耑防鏇髓內釘（ proxi-mal femoral nail anti-rotation，PFNA）手術對股骨近耑解剖形態的影響。方法：利用Mimics等計算機輔助設計（ com-puter assisted design，CAD）軟件，建立一種在三維條件下，測量股骨近耑三維（3 dimensional，3D）解剖形態的方法，併完成信度實驗。收集40例股骨粗隆間骨摺患者行InterTAN和PFNA術後的CT數據，測量術後健側和患側的2D、3D前傾角和頸榦角，髓內釘2D、3D前傾角。利用組內相關繫數（intra-class correlation coefficient，ICC）檢驗股骨頸前傾角、頸榦角等數據間的一緻性，成對t檢驗比較成對數據的差異。結果：所建立測量方法的觀察者間和觀察者內信度均較高（ICC均大于0．9）。配對t檢驗顯示不同髓內釘術後患側前傾角與健側前傾角相比差異均無統計學意義，一緻性檢驗顯示，患側和健側的2D、3D前傾角之間併無一緻性（ P分彆為0．099和0．055）；但髓內釘2D、3D前傾角和患側相應的2D、3D前傾角之間的一緻性較好（總體ICC分彆為0．81和0．8，P值均小于0．001）。 PF-NA組術後患側前傾角與健側的差值大于15°者佔57％，明顯高于InterTAN組的16％，配對t檢驗顯示，PFNA術後的患側和健側的2D和3D頸榦角之間差異無統計學意義（P值分彆為0．925和0．367）， InterTAN術後患側的2D和3D頸榦角均明顯小于健側，差異有統計學意義（ P值分彆為0．033和0．009）。結論：通過對兩種髓內釘術後股骨近耑解剖形態的測量髮現，與InterTAN相比，PFNA術後股骨頸前傾角變化較大，兩種髓內釘的前傾角與術後患側股骨頸前傾角均有較彊的相關性。
목적：건립일충고골근단삼유해부형태적측량방법，연구InterTAN수내정화고골근단방선수내정（ proxi-mal femoral nail anti-rotation，PFNA）수술대고골근단해부형태적영향。방법：이용Mimics등계산궤보조설계（ com-puter assisted design，CAD）연건，건립일충재삼유조건하，측량고골근단삼유（3 dimensional，3D）해부형태적방법，병완성신도실험。수집40례고골조륭간골절환자행InterTAN화PFNA술후적CT수거，측량술후건측화환측적2D、3D전경각화경간각，수내정2D、3D전경각。이용조내상관계수（intra-class correlation coefficient，ICC）검험고골경전경각、경간각등수거간적일치성，성대t검험비교성대수거적차이。결과：소건립측량방법적관찰자간화관찰자내신도균교고（ICC균대우0．9）。배대t검험현시불동수내정술후환측전경각여건측전경각상비차이균무통계학의의，일치성검험현시，환측화건측적2D、3D전경각지간병무일치성（ P분별위0．099화0．055）；단수내정2D、3D전경각화환측상응적2D、3D전경각지간적일치성교호（총체ICC분별위0．81화0．8，P치균소우0．001）。 PF-NA조술후환측전경각여건측적차치대우15°자점57％，명현고우InterTAN조적16％，배대t검험현시，PFNA술후적환측화건측적2D화3D경간각지간차이무통계학의의（P치분별위0．925화0．367）， InterTAN술후환측적2D화3D경간각균명현소우건측，차이유통계학의의（ P치분별위0．033화0．009）。결론：통과대량충수내정술후고골근단해부형태적측량발현，여InterTAN상비，PFNA술후고골경전경각변화교대，량충수내정적전경각여술후환측고골경전경각균유교강적상관성。
Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in InterTAN group.The paired student T-test showed no significant difference between the post-operative injured side’ s 2D or 3D NS angles and the in-tact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively).Conclusion:By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group.There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.
