Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Department of Medical Statistic, Tongji University School of Medicine, Shanghai, China.
Comput Methods Programs Biomed. 2022 Jul;222:106958. doi: 10.1016/j.cmpb.2022.106958. Epub 2022 Jun 16.
Bone defects in femoral neck fractures are strongly associated with the prognosis after internal fixation. However, qualitative analysis of bone defects in femoral neck fractures has already been performed, quantitative studies have not been reported. In this study, we aimed to systematically analyse the morphological characteristics of bone defects in patients with femoral neck fractures using computed tomography (CT) images combined with computer image analysis techniques.
Four hundred and sixty-nine patients with femoral neck fractures from January 2014 to December 2018 at two grade A tertiary hospitals were included. Models were created in Mimics software based on CT images collected within 1 week after injury and then imported into 3-matic software for virtual reduction. The volume of the bone defect (VBD), maximum defect thickness (MDT), extent of the bone defect region (EBDR) , main defect quadrant (MDQ), collapse type and fracture classification were calculated and recorded.
The EBDR, collapse type and MDT all had a significant positive effect on the VBD (P <0.05), with a more significant effect at higher quantiles. Age also had a significant positive effect on the VBD (P < 0.05), but its effect was more pronounced at lower quantiles. Compared to non-subcapital fractures, subcapital fractures had a positive effect on the VBD only at the 50 and 75% quantiles (P < 0.01). The female sex had a significant negative effect on the VBD compared to the male sex (P < 0.05).
This study established a reliable computer image processing method for quantitative analysis of the VBD in femoral neck fractures and revealed that all patients with femoral neck fractures had bone defects, which can occur at any part of the femoral neck. The EBDR, MDT, collapse type, and patient age and sex were all important risk factors for the extent of the defect and should be taken into account in surgical planning.
股骨颈骨折中的骨缺损与内固定后的预后密切相关。然而，已有对股骨颈骨折中骨缺损的定性分析，但尚未有定量研究。本研究旨在通过 CT 图像结合计算机图像分析技术，对股骨颈骨折患者的骨缺损形态特征进行系统分析。
纳入 2014 年 1 月至 2018 年 12 月在 2 家三甲医院就诊的 469 例股骨颈骨折患者。根据伤后 1 周内采集的 CT 图像在 Mimics 软件中建立模型，然后导入 3-matic 软件进行虚拟复位。计算并记录骨缺损体积（VBD）、最大缺损厚度（MDT）、骨缺损区域范围（EBDR）、主要缺损象限（MDQ）、塌陷类型和骨折分型。
EBDR、塌陷类型和 MDT 对 VBD 均有显著的正影响（P<0.05），在更高分位数时影响更显著。年龄对 VBD 也有显著的正影响（P<0.05），但在更低分位数时影响更显著。与非转子下骨折相比，转子下骨折仅在 50%和 75%分位数对 VBD 有正影响（P<0.01）。与男性相比，女性 VBD 显著更小（P<0.05）。
本研究建立了一种可靠的计算机图像处理方法，可对股骨颈骨折的 VBD 进行定量分析，结果显示所有股骨颈骨折患者均存在骨缺损，可发生在股骨颈的任何部位。EBDR、MDT、塌陷类型、患者年龄和性别均是缺损程度的重要危险因素，应在手术计划中加以考虑。
