Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
J Orthop Surg Res. 2023 Sep 19;18(1):703. doi: 10.1186/s13018-023-04205-6.
Internal fixation of the femoral neck carries a risk of perforation due to the presence of the isthmus of the femoral neck. At present, there are few studies on the safe and risk zones of the femoral neck system (FNS) implantation. This study aimed to recommend the safe range of injection of FNS in the lateral wall of the proximal femur, parallel to the axis of the femoral neck, during FNS treatment of femoral neck fracture (FNF).
Femoral computed tomography (CT) data of 80 patients (male: 40; female: 40) who met the inclusion criteria were collected. Mimics 21.0 software was used to complete the modeling. 3-Matic 13.0 software was used to establish the axis of the femoral neck and its vertical plane, perform the cutting of the femoral neck, and project it on the vertical plane of the femoral neck axis. After matching a rectangle for each projection map, all sample sizes (80 cases) were standardized and superimposed to obtain gradient maps of the safe zone (SZ) and dangerous zone (RZ), thereby securing edge key points and safe FNS insertion range.
In the 80 samples, the mean diameter of the smallest femoral neck section was 33.87 ± 2.32 mm for men and 29.36 ± 1.92 mm for women. All 80 femoral necks had safe and risky areas. The SZ/S × 100% was 77.59 (± 2.22%), and the RS/S × 100% was 22.39% (± 2.22%). The risk area was composed of four parts: (1), (2), (3), and (4), respectively, corresponding to 3.45 ± 1.74%, 5.51 ± 2.63%, 6.22 ± 1.41%, and 7.22 ± 1.39%. Four marginal key points, perforation risk, and safe ranges (SR) of FNS were analyzed on the lateral wall of the femoral neck.
The SR of FNS placement was recommended by digital simulation. In addition, Regions (3) and (4) posed a higher risk of penetrating the cortex. Using the gradient map of RZ for preoperative evaluation is recommended to avoid iatrogenic perforation.
由于股骨颈峡部的存在，股骨颈内固定有穿透的风险。目前，关于股骨颈系统（FNS）植入的安全和危险区域的研究较少。本研究旨在推荐 FNS 治疗股骨颈骨折（FNF）时，在股骨颈轴平行的股骨近端外侧壁注射 FNS 的安全范围。
收集符合纳入标准的 80 例患者（男 40 例，女 40 例）的股骨 CT 数据。使用 Mimics 21.0 软件完成建模。使用 3-Matic 13.0 软件建立股骨颈轴及其垂直平面，进行股骨颈切割，并将其投影到股骨颈轴的垂直平面上。为每个投影图匹配一个矩形后，对所有样本大小（80 例）进行标准化和叠加，以获得安全区（SZ）和危险区（RZ）的梯度图，从而确定边缘关键点和安全的 FNS 插入范围。
在 80 个样本中，男性最小股骨颈段的平均直径为 33.87 ± 2.32mm，女性为 29.36 ± 1.92mm。所有 80 个股骨颈均有安全和危险区域。SZ/S×100%为 77.59（±2.22%），RS/S×100%为 22.39%（±2.22%）。危险区由四个部分组成：（1）、（2）、（3）和（4），分别对应 3.45 ± 1.74%、5.51 ± 2.63%、6.22 ± 1.41%和 7.22 ± 1.39%。在股骨颈外侧壁分析了四个边缘关键点、FNS 穿孔风险和安全范围（SR）。
通过数字模拟推荐了 FNS 放置的 SR。此外，区域（3）和（4）穿透皮质的风险较高。建议使用 RZ 的梯度图进行术前评估，以避免医源性穿透。
