Wang Yongqin, Xu Zihuan, Li Pengfei, Zhang Yingqi, Su Zhihao, Ni Ming
School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, P. R. China.
Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, 201299, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 15;36(9):1078-1083. doi: 10.7507/1002-1892.202204035.
To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment.
A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels' angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution.
According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels' angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from -39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar.
The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.
通过医学图像分析和骨折映射技术分析中青年股骨颈骨折的特点，为骨折治疗提供参考。
分析2018年12月至2019年7月收治的159例中青年股骨颈骨折患者的临床资料。其中男性99例，女性60例。年龄18～60岁，平均年龄47.9岁。左侧股骨颈骨折77例，右侧82例。根据术前X线片和CT，观察骨折形态，并分别按照Garden分型标准和Pauwels角进行分类。采用Mimics19.0软件重建股骨颈骨折的三维模型，测量骨折平面与人体矢状面的夹角，观察骨折端有无缺损及其在骨折面上的位置。通过重建、虚拟复位和图像叠加，建立骨折图谱以观察骨折线及分布情况。
按照Garden分型标准，Ⅰ型6例，Ⅱ型61例，Ⅲ型54例，Ⅳ型38例。按照Pauwels角，外展型12例，中间型78例，内收型69例。骨折平面与人体矢状面的夹角为-39°至+30°。以GardenⅡ型、Ⅳ型及Pauwels中间型为主。骨折块主要呈基底较长的三角形，主要分布于股骨头颈交界区下方。26例（16.35%）合并骨缺损，多发生于GardenⅢ型、Ⅳ型及Pauwels中间型，位于股骨颈后方，多累及2～4个象限。骨折图谱显示，股骨颈骨折线沿股骨头颈交界呈环形分布。股骨颈上方骨折线密集，下方稀疏，累及股骨距。
中青年股骨颈骨折中移位骨折（GardenⅢ型、Ⅳ型）和不稳定骨折（Pauwels中间型、内收型）比例较高，粉碎性骨折和骨缺损进一步增加了治疗难度。临床实践中，需根据骨折特点选择治疗方案。解剖复位和有效固定是中青年股骨颈骨折治疗的首要原则。
