Zhao Jing-xin, Su Xiu-yun, Zhao Zhe, Zhang Li-cheng, Mao Zhi, Zhang Hao, Zhang Li-hai, Tang Pei-fu
Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
Department of Orthopaedics, Affiliated Hospital of the Academy of Military Medical Sciences, No.8 Dongdajie Road, Beijing, 100071, People's Republic of China.
Int J Comput Assist Radiol Surg. 2015 Oct;10(10):1557-65. doi: 10.1007/s11548-015-1182-5. Epub 2015 Apr 1.
To establish a new reliable approach for measuring proximal femoral anatomical parameters and determining the optimal entry point of the antegrade intramedullary (IM) nailing.
A new method for measuring the proximal femoral anatomy and locating the optimal entry point for the antegrade nailing was developed using Mimics and 3-Matic softwares (Materialise, Haasrode, Belgium). After verifying the reliability of the measurement method using 15 pairs of the femoral models by the intraclass correlation coefficient, the anatomical parameters of 200 Chinese femurs were measured, and statistical analyses were performed to compare the proximal femoral anatomical parameters between different genders or lateralities and determine the most relevant factors of the optimal entry point.
Reliability study showed that both intraobserver reliability and interobserver reliability of the current measurement approach were excellent. After independent samples [Formula: see text]-test, the proximal femoral anatomical parameters were shown significant difference between genders. Stepwise regression statistical analyses showed that the most relevant factors of the distances between the optimal entry point and the femoral head centre, the femoral neck axis and the tip of the greater trochanter were the 3D femoral neck-shaft angle (Pearson's [Formula: see text]; the model's [Formula: see text]), the femoral radius (Pearson's [Formula: see text]; the model's [Formula: see text]) and the femoral length (Pearson's r = 0.316; the model's [Formula: see text]), respectively.
The current study provided a new and reliable measurement approach to evaluating the anatomical morphology of the proximal femur and revealed the most influential factors on the locations of the simulated optimal entry point for the proximal femoral antegrade IM nailing. Furthermore, this study was useful for establishing methodological basis for future researches and developments of the custom-made IM nailing and affiliated surgical instruments.
建立一种测量股骨近端解剖参数并确定顺行髓内钉最佳进针点的新的可靠方法。
使用Mimics和3-Matic软件（Materialise，比利时哈瑟罗德）开发了一种测量股骨近端解剖结构并定位顺行髓内钉最佳进针点的新方法。通过组内相关系数验证15对股骨模型测量方法的可靠性后，测量200例中国成年人股骨的解剖参数，并进行统计分析，比较不同性别或侧别之间的股骨近端解剖参数，确定最佳进针点的最相关因素。
可靠性研究表明，当前测量方法的观察者内可靠性和观察者间可靠性均极佳。独立样本t检验显示，股骨近端解剖参数在性别之间存在显著差异。逐步回归统计分析表明，最佳进针点与股骨头中心、股骨颈轴线和大转子尖端之间距离的最相关因素分别是三维股骨颈干角（Pearson相关系数r = 0.624；模型的F = 75.213）、股骨半径（Pearson相关系数r = 0.532；模型的F = 47.623）和股骨长度（Pearson相关系数r = 0.316；模型的F = 12.654）。
本研究提供了一种新的可靠测量方法来评估股骨近端的解剖形态，并揭示了股骨近端顺行髓内钉模拟最佳进针点位置的最有影响因素。此外，本研究为定制髓内钉及附属手术器械的未来研究和开发建立方法学基础提供了帮助。
