非移位型股骨颈骨折发生股骨头后倾角的研究
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作者Author单位AddressE-Mail
俞荣耀 YU Rong-yao 宁波大学医学部, 浙江 宁波 315211 School of Medicine, Ningbo Universitly, Ningbo 315211, Zhejiang, China  
庞清江 PANG Qing-jiang 中国科学院大学宁波华美医院骨科, 浙江 宁波 315000 Department of Orthopaedics, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, Zheiiang, China pangqingjiang@ucas.ac.cn 
期刊信息:《中国骨伤》2024年,第37卷,第5期,第476-481页
DOI:10.12200/j.issn.1003-0034.20221307
基金项目:
中文摘要:

目的:探讨临床非移位型股骨颈骨折后发生股骨头后倾情况为临床手术和改善疾病预后提供参考依据。

方法:回顾性分析2018年1月至2022年6月收治的非移位型GardenⅠ、Ⅱ型股骨颈骨折患者165例临床资料,男48例,女117例;年龄53~89(71.5±8.5)岁;GardenⅠ型97例,Ⅱ型68例。在术前髋关节矢状位或轴位CT片上,将股骨头半径线与股骨颈中线形成的夹角作为股骨头后倾角α,测量股骨头后倾角大小。并将测量数据分成6组:α<0°、0°<α<5°、5° ≤ α<10°、10° ≤ α<15°、15° ≤ α<20°、α ≥ 20°,比较不同范围后倾角的发生情况。分析比较165例患者性别构成比,并将65岁作为分界点,比较不同性别患者的骨折发生情况。根据术前后倾角大小分为后倾角<20°组135例和后倾角 ≥ 20°组30例,分析比较两组患者在性别和年龄上的差异。

结果:165例非移位型股骨颈骨折的患者中,发生股骨头后倾143例(86.7%),其中,后倾0°<α<5°36例(21.8%),5° ≤ α<10°40例(24.2%);10° ≤ α<15°27例(16.4%),15° ≤ α<20°10例(6.1%),后倾角α ≥ 20°30例(18.2%),其中最大后倾角为42.7°。165例患者中,女性骨折占比高于男性,且相比男性,女性在65岁前更易发生骨折。但性别、年龄和Garden分型(Ⅰ、Ⅱ型)不是股骨颈骨折术前股骨头后倾角>20°的影响因素(P>0.05)。

结论:非移位型股骨颈骨折发生股骨头后倾的比率较高,其中发生严重后倾,即股骨头后倾角 ≥ 20°可达18.2%。对于行闭合复位内固定的患者,需要尽可能将骨折断端复位以降低发生术后股骨头缺血性坏死的风险。为了预防股骨颈骨折的发生,要特别重视对于女性的抗骨质疏松治疗。对于不同年龄段、不同性别和Garden分型Ⅰ、Ⅱ型患者,术前评估后倾角都至关重要。
【关键词】非移位型股骨颈骨折  后倾角  性别  年龄
 
Clinical study on the incidence of femoral head posterior tilt angle in non-displaced femoral neck fractures
ABSTRACT  

Objective To investigate the occurrence of posterior femoral head tilt after clinical non-displaced femoral neck fracture,and to provide a reference basis for clinical surgery and improvement of disease prognosis.

Methods Total of 165 patients with non-displaced femoral neck fractures of Garden typeⅠand Ⅱ from January 2018 to June 2022 were selected as study subjects including 48 males and 117 females,with an average age of (71.5±8.5) years old ranging from 53 to 89,involving 97 cases of typeⅠand 68 of typeⅡ. On the patient's preoperative sagittal or axial CT film of the hip,the angle formed by the radius line of the femoral head and the midline of the femoral neck was used as the posterior tilt angle of the femoral head (α),and the posterior tilt femoral head angle was measured using the method proposed by Palm. The measured data were divided into 6 groups:α<0°,0°<α< 5°,5° ≤ α<10°,10° ≤ α<15°,15° ≤ α<20°,α ≥ 20°,and the incidence of different ranges of posterior tilt angle was compared. The sex composition ratio of 165 patients were analyzed and compared,and the age of 65 was used as the cut-off point to compare the incidence of fractures between genders. Patients were divided into the posterior tilt <20° group for 135 cases and the posterior tilt ≥ 20°group for 30 cases according to the preoperative posterior tilt angle,the differences between two groups in terms of gender and age were analyzed.

Results Among 165 patients with non-displaced femoral neck fractures,143 cases with poaterior tilt of the femoral head occurred with an incidence of 86.7%. Posterior tilt 0°<α<5° accounted for 36 cases with an incidence of 21.8%;5° ≤ α<10° accounted for 40 cases with an incidence of 24.2%;10° ≤ α<15° accounted for 27 cases with an incidence of 16.4%;15° ≤ α<20° accounted for 10 cases with an incidence of 6.1%;posterior tilt angle α ≥ 20° accounted for 30 cases,the incidence was 18.2%,of which the maximum posterior tilt angle was 42.7°. Statistical analysis showed that the percentage of fractures in the 165 patients selected for this study was significantly higher in female than in male,and that the female group was more likely to have fractures before the age of 65 years compared to the male group. However,gender,age and fracture subtypes (GardenⅠ,Ⅱ) were not influential factors for femoral neck fractures with a preoperative posterior femoral head tilt angle >20°(P>0.05).

Conclusion The incidence of femoral head posterior tile in non-displaced femoral neck fractures is relatively high,in which severe posterior tile occurs,and the femoral head posterior tile angle ≥ 20° can reach 18.2%. In patients with closed reduction internal fixation,the fracture end needs to be repositioned as much as possible to reduce the risk of postoperative avascular necrosis of the femoral head. In order to prevent femoral neck fractures,special attention should be paid to anti-osteoporosis treatment for female. Preoperative assessment of posterior tilt is critical for patients of different ages,genders and fracture subtypes (GardenⅠ,Ⅱ).
KEY WORDS  Non-displaced femoral neck fracture  Posterior tile angle  Gender  Age
 
引用本文,请按以下格式著录参考文献:
中文格式:俞荣耀,庞清江.非移位型股骨颈骨折发生股骨头后倾角的研究[J].中国骨伤,2024,37(5):476~481
英文格式:YU Rong-yao,PANG Qing-jiang.Clinical study on the incidence of femoral head posterior tilt angle in non-displaced femoral neck fractures[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(5):476~481
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