PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：使用柔性髓内钉（IM）治疗股骨干骨折后的旋转变化一直是许多外科医生关注的问题。最近,建立了统计形状模型（SSM），用于从二维平面射线照片对股骨进行三维重建。在这项研究中,我们测量了使用柔性IM钉治疗的股骨干骨折患者的术后股骨前倾(FAV),并使用SSM调查了FAV的年龄相关变化.
方法：本研究使用了从韩国六个专门研究小儿创伤的地区三级中心收集的影像学数据。包括在2002年9月至2020年6月之间诊断为股骨干骨折的患者以及年龄<18岁的患者，其中至少两次前后（AP）和外侧（LAT）股骨平片至少间隔三个月。线性混合模型(LMM)用于统计分析。
结果：总体而言，72名患者被纳入研究。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°。在72名患者中，52例患者（72.2％）显示术后即刻FAV大于20°。初始FAV>20°患者的平均FAV为32.74°，LMM显示，从最初的创伤开始，FAV每增加1年，下降2.5°（p=0.0001）。
结论：这项研究使用新开发的技术探索了股骨干骨折后FAV的变化，该技术允许从未校准的2D图像进行3D重建。初始固定后股骨的旋转有变化，FAV每年减少2.5°。
方法：本研究使用了从韩国六个专门研究小儿创伤的地区三级中心收集的影像学数据。包括在2002年9月至2020年6月之间诊断为股骨干骨折的患者以及年龄<18岁的患者，其中至少两次前后（AP）和外侧（LAT）股骨平片至少间隔三个月。线性混合模型(LMM)用于统计分析。
结果：总体而言，72名患者被纳入研究。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°。在72名患者中，52例患者（72.2％）显示术后即刻FAV大于20°。初始FAV>20°患者的平均FAV为32.74°，LMM显示，从最初的创伤开始，FAV每增加1年，下降2.5°（p=0.0001）。
结论：这项研究使用新开发的技术探索了股骨干骨折后FAV的变化，该技术允许从未校准的2D图像进行3D重建。初始固定后股骨的旋转有变化，FAV每年减少2.5°。
