Du Chang-ling, Ma Xin-long, Zhang Tao, Ma Jian-xiong, Sun Xiao-lei, Wang Shu-li, Fu Xin, Lu Jin
Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China.
Zhonghua Wai Ke Za Zhi. 2012 Oct;50(10):889-93.
To measure the displacement parameters of femoral head in space through three-dimensional reconstruction so as to reunderstand undisplaced femoral neck fractures.
The clinical data of 80 undisplaced femoral neck fractures from January 2010 to June 2011 were selected, included Garden I 40 cases (group Garden I) and Garden II 40 cases (group Garden II), bilateral proximal femurs of everyone were scanned by CT and reconstructed by professional software. Registered the normal femur and fracture with mirror model, marked key points in the model and measured the displacement parameters of femoral head. The measurement accuracy of distance and angle were 0.01 mm and 0.01°, respectively. The parameters of femoral head displacement between group Garden I and Garden II were analyzed by independent-sample t-test.
Eighty cases on X-ray films were not found rotated displacement. But 24 cases of them (30.0%) showed rotated displacement and rotation direction of the femoral head through three-dimensional reconstruction. Ten cases showed incomplete fractures on X-ray films, but only 3 cases were incomplete fractures with three-dimensional reconstruction. In group Garden I, the femoral head displacement angle was 18° ± 11°, the average displacement distance of femoral head center and deepest point of fovea capitis were (6 ± 3) mm and (10 ± 6) mm respectively. In group Garden II, the femoral head displacement angle was 17° ± 10°, the average displacement distance of femoral head center and deepest point of fovea capitis were (7 ± 5) mm and (13 ± 8) mm respectively. There were not statistical significance of the parameters of femoral head displacement between group Garden I and Garden II (P > 0.05).
Three-dimensional reconstruction and digital measurement is a precise, efficient method for the measurement of femoral head displacement parameters in femoral neck fractures, has important clinical significance in the diagnosis and treatment of the femoral neck fractures. There are certain defects and limitations of the classical Garden classification for undisplaced femoral neck fractures.
通过三维重建测量股骨头在空间中的位移参数，以重新认识无移位股骨颈骨折。
选取2010年1月至2011年6月期间80例无移位股骨颈骨折的临床资料，其中Garden I型40例（Garden I组），Garden II型40例（Garden II组），对所有人的双侧股骨近端进行CT扫描并用专业软件重建。将正常股骨和骨折用镜像模型配准，在模型上标记关键点并测量股骨头的位移参数。距离和角度的测量精度分别为0.01 mm和0.01°。采用独立样本t检验分析Garden I组和Garden II组之间股骨头位移参数。
X线片上80例均未发现旋转位移。但通过三维重建发现其中24例（30.0%）出现股骨头旋转位移及旋转方向。X线片上10例显示不完全骨折，但三维重建仅3例为不完全骨折。Garden I组中，股骨头位移角度为18°±11°，股骨头中心与股骨头凹最深点的平均位移距离分别为(6±3)mm和(10±6)mm。Garden II组中，股骨头位移角度为17°±10°，股骨头中心与股骨头凹最深点的平均位移距离分别为(7±5)mm和(13±8)mm。Garden I组和Garden II组之间股骨头位移参数差异无统计学意义（P>0.05）。
三维重建及数字化测量是测量股骨颈骨折中股骨头位移参数的精确、有效方法，对股骨颈骨折的诊断和治疗具有重要临床意义。经典的Garden分型对无移位股骨颈骨折存在一定缺陷和局限性。
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