Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Asian J Surg. 2021 Jan;44(1):66-71. doi: 10.1016/j.asjsur.2020.10.010. Epub 2020 Nov 28.
The incidence of intertrochanteric femoral fractures has rapidly increased with the extended lifespan of the elderly population. Surgery enables early ambulation by achieving anatomic reduction and stable internal fixation. However, reduction usually involves postoperative evaluation. Here, we present reliable parameters obtained from analyses of three-dimensional computed tomography images from cadavers to serve as guidelines during the reduction of intertrochanteric fractures. We included 184 three-dimensional modeling samples from cadavers placed in two standardized positions, similar to C-arm imaging. We recorded the level of the orthogonal line from the greater trochanter (GT) tip to the femoral head (GT orthogonal line [GTOL]) in the anteroposterior view and the line along the anterior femoral cortex passing through the femoral head (anterior cortical line) in the axial view. Correlations between these lines and angular alignments were statistically determined. The GTOL passed above the femoral head center at mean 2.36 mm in all patients; 77.17% of such instances were in the upper second quadrant of the femoral head. The anterior cortical line passed under the femoral head center at mean 10.82 mm; 73.37% of such instances were in the inferior one-third of the femoral head. Consistent correlations were found between the GTOL and neck-shaft angle and between the anterior cortical line and anteversion. The GTOL and anterior cortical line passed through a constant level of the femoral head in most samples and were correlated with angular alignments. The intraoperative use of these simple imaginary lines improves the intertrochanteric fracture reduction quality.
随着老年人口寿命的延长，股骨转子间骨折的发病率迅速增加。手术通过实现解剖复位和稳定的内固定使患者能够早期下地活动。然而，复位通常需要术后评估。在这里，我们从尸体的三维 CT 图像分析中获得了可靠的参数，作为转子间骨折复位过程中的指导。我们纳入了 184 个来自尸体的三维建模样本，这些样本被放置在类似于 C 臂成像的两个标准化位置。我们记录了前后位从大转子（GT）尖端到股骨头（GT 正交线[GTOL]）的正交线的水平，以及在轴位沿股骨前皮质穿过股骨头的线（前皮质线）。这些线与角度对齐之间的相关性通过统计学确定。在所有患者中，GTOL 均位于股骨头中心上方，平均为 2.36mm；77.17%的情况位于股骨头的上二分之一象限。前皮质线在股骨头中心下方平均 10.82mm 通过；73.37%的情况位于股骨头的下三分之一。GTOL 与颈干角之间以及前皮质线与前倾角之间存在一致的相关性。GTOL 和前皮质线在大多数样本中穿过股骨头的恒定水平，并与角度对齐相关。在手术过程中使用这些简单的想象线可以提高转子间骨折复位的质量。
