股骨近端几何形态：股骨近端骨折亚型的主要预测因素。

Faculty of Medicine University of Porto, Portugal.

Department of Orthopaedics and Traumatology, Baixo Vouga Hospital Centre, Aveiro, Portugal.

Hip Int. 2023 Nov;33(6):1100-1106. doi: 10.1177/11207000221129785. Epub 2022 Oct 17.

INTRODUCTION

Proximal femur geometry (PFG) represents an important risk factor for the occurrence of hip fractures. There are currently few studies regarding the correlation between PFG and the occurrence of a specific fracture subtype, and those that exist have small cohorts and present with different methodologies and contradictory results. Therefore, there is no consensus in the literature regarding this topic. The present study aimed to establish the contribution of the PFG in the occurrence of different subtypes of proximal femur fractures (PFF): intertrochanteric, neck and subtrochanteric.

METHODS

Analysis of 1022 plain anteroposterior pelvic radiographs of patients consecutively admitted to the emergency room of a Level 1 Trauma Centre between 2013 and 2019 after low energy trauma who presented with PFF and underwent surgical treatment. Patients were analysed considering age, gender and subtype of PFF (intertrochanteric, neck or subtrochanteric). Radiological parameters including cervicodiaphyseal angle (CDA), horizontal offset (HO), femoral neck width (FNW), femoral neck length (FNL), great trochanter-pubic symphysis distance (GTPSD), acetabular teardrop distance (ATD) and width of the intertrochanteric region (WIR) were measured and compared between the different subtypes of fractures (7154 measurements). Statistical analysis was conducted recurring to absolute measurements and measurements ratios. The correlation was assessed using -test.

RESULTS

There were statistically significant differences in proximal femur geometry between the different subtypes of fractures. Patients presenting with femoral neck fractures had greater CDA (132.5 ± 6.9 vs. 130.0 ± 7.3; 0.001) and lower HO (45.8 ± 7.4 vs. 49.0 ± 8.0; 0.001), HO/ATD (0.34 ± 0.068 vs. 0.37 ± 0.072; 0.001) and HO/GTPSD (0.26 ± 0.049 vs. 0.28 ± 0.039; 0.001) than patients with intertrochanteric/subtrochanteric fractures.

CONCLUSIONS

PFG represents an important contributor to the occurrence of different fracture subtypes. Femoral neck fractures are associated with greater CDA and lower HO, HO/ATD and HO/GTPSD when compared to intertrochanteric or subtrochanteric fractures.

简介

股骨近端几何形状（PFG）是髋部骨折发生的一个重要危险因素。目前关于 PFG 与特定骨折亚型发生的相关性的研究较少，而且这些研究的队列规模较小，采用的方法不同，结果也相互矛盾。因此，目前文献中尚无定论。本研究旨在确定 PFG 在不同类型股骨近端骨折（PFF）中的作用：转子间、颈和转子下。

方法

对 2013 年至 2019 年期间因低能量创伤连续入住 1 级创伤中心急诊室并接受手术治疗的 PFF 患者的 1022 例前后位骨盆平片进行分析。患者按年龄、性别和 PFF 亚型（转子间、颈或转子下）进行分析。测量并比较了包括颈干角（CDA）、水平偏移（HO）、股骨颈宽度（FNW）、股骨颈长度（FNL）、大转子-耻骨联合距离（GTPSD）、髋臼泪滴距离（ATD）和转子间区宽度（WIR）在内的影像学参数，并比较了不同骨折亚型之间的差异（7154 次测量）。统计分析采用绝对值测量值和测量值比值。使用 -检验评估相关性。

结果

不同骨折亚型的股骨近端几何形状存在统计学差异。股骨颈骨折患者的 CDA 更大（132.5±6.9 比 130.0±7.3； 0.001），HO 更小（45.8±7.4 比 49.0±8.0； 0.001），HO/ATD 更小（0.34±0.068 比 0.37±0.072； 0.001），HO/GTPSD 更小（0.26±0.049 比 0.28±0.039； 0.001），而转子间/转子下骨折患者的 CDA 更大，HO 更小，HO/ATD 和 HO/GTPSD 更小。