Department of Orthopaedic Surgery, Chaim Sheba Medical Centre, Israel.
Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Centre, Israel.
Hip Int. 2020 Sep;30(5):629-634. doi: 10.1177/1120700019859275. Epub 2019 Jul 11.
To determine if boney morphology influences the anatomic location of hip fractures in elderly patients.
All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign.
148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA ( 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures ( 0.013).
Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.
确定骨形态是否影响老年患者髋部骨折的解剖位置。
回顾了 2008 年至 2012 年间所有在骨折前拍摄过髋关节 X 光片的髋部骨折患者。将骨折分为囊内和囊外，并在骨折前 X 光片上测量髋关节形态。髋关节形态通过 alpha 角、外侧中心边缘角、髋臼指数、颈干角、髋关节轴长度、股骨颈直径、髋关节骨关节炎（OA）的 Tönnis 分级和交叉征的存在来确定。
共纳入 148 例（78.4%为女性，年龄 83.5 岁）股骨近端骨折患者。44 例（29.7%）为囊内骨折，104 例（70.3%）为囊外骨折。48%的患者对侧有先前的髋部骨折，74.6%的患者双侧骨折类型相同。双侧囊内和囊外骨折的发生率相似（分别为 33.7%和 40.9%，0.39）。囊外骨折的颈干角显著较高，髋关节轴长度较短，股骨颈直径较窄，OA 的 Tönnis 分级较高（分别为 0.04、0.046、0.03、0.02）。通过外侧中心边缘角（LCEA）、髋臼指数和交叉征评估的髋臼覆盖范围和股骨近端头颈交界处与骨折类型无关。alpha 角>40°与囊外骨折有显著更高的相关性（0.013）。
髋臼覆盖范围和股骨近端头颈交界处形态与髋部骨折的位置部分相关，但不能完全阐明骨折类型的易感性。
