Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Sungnam, 13620, Gyeonggi, Korea.
Departments of Mathematics and Department of Artificial Intelligence, Ajou University, Gyeonggi, Korea.
BMC Musculoskelet Disord. 2024 Jul 12;25(1):534. doi: 10.1186/s12891-024-07566-z.
The rotational change after using a flexible intramedullary (IM) nail for femoral shaft fractures has been a concern for many surgeons. Recently, a statistical shape model (SSM) was developed for the three-dimensional reconstruction of the femur from two-dimensional plain radiographs. In this study, we measured postoperative femoral anteversion (FAV) in patients diagnosed with femoral shaft fractures who were treated with flexible IM nails and investigated age-related changes in FAV using the SSM.
This study used radiographic data collected from six regional tertiary centers specializing in pediatric trauma in South Korea. Patients diagnosed with femoral shaft fractures between September 2002 and June 2020 and patients aged < 18 years with at least two anteroposterior (AP) and lateral (LAT) femur plain radiographs obtained at least three months apart were included. A linear mixed model (LMM) was used for statistical analysis.
Overall, 72 patients were included in the study. The average patient age was 7.6 years and the average follow-up duration was 6.8 years. The average FAV of immediate postoperative images was 27.5 ± 11.5°. Out of 72 patients, 52 patients (72.2%) showed immediate postoperative FAV greater than 20°. The average FAV in patients with initial FAV > 20° was 32.74°, and the LMM showed that FAV decreased by 2.5° (p = 0.0001) with each 1-year increase from the time of initial trauma.
This study explored changes in FAV after femoral shaft fracture using a newly developed technology that allows 3D reconstruction from uncalibrated 2D images. There was a pattern of change on the rotation of the femur after initial fixation, with a 2.5° decrease of FAV per year.
使用弹性髓内钉治疗股骨干骨折后发生的旋转变化一直是许多外科医生关注的问题。最近，开发了一种统计形状模型（SSM），用于从二维平片重建股骨的三维结构。在这项研究中，我们测量了使用弹性髓内钉治疗的股骨干骨折患者的术后股骨前倾角（FAV），并使用 SSM 研究了 FAV 与年龄的相关性变化。
本研究使用了韩国六个专门从事儿科创伤的区域三级中心收集的影像学资料。纳入 2002 年 9 月至 2020 年 6 月期间诊断为股骨干骨折且年龄<18 岁的患者，至少有两张至少相隔三个月获得的前后位（AP）和侧位（LAT）股骨平片。采用线性混合模型（LMM）进行统计学分析。
共有 72 例患者纳入研究。患者平均年龄为 7.6 岁，平均随访时间为 6.8 年。术后即刻图像的平均 FAV 为 27.5°±11.5°。72 例患者中，52 例（72.2%）术后即刻 FAV>20°。初始 FAV>20°的患者平均 FAV 为 32.74°，LMM 显示，FAV 随初始创伤后每年增加 1 岁而减少 2.5°（p=0.0001）。
本研究使用一种新开发的技术，从未经校准的二维图像即可进行 3D 重建，探讨了股骨干骨折后 FAV 的变化。初始固定后股骨旋转有变化模式，FAV 每年减少 2.5°。
