目的:随着骨质疏松的进展,股骨近端的主要压缩小梁(PCT)保留下来,被认为是连接股骨头和股骨颈的主要承重结构.本研究旨在阐明老年人群股骨近端PCT的分布规律,并评估其对髋部骨折手术中使用的内固定装置的开发和优化的意义。
方法:这是一项从2022年3月至2023年4月进行的回顾性队列研究。共纳入在我院接受双侧髋关节CT扫描的125例患者。分析未患侧髋关节的CT数据。测量了股骨近端PCT分布的关键参数,包括股骨头半径(R),颈轴角度(NSA),PCT轴和头颈轴之间的角度(α),从股骨头中心到PCT轴的距离(δ),以及PCT的底部和顶部边界的长度(分别为L-底部和L-顶部)。还调查了性别差异对PCT分布模式的影响。学生t检验或曼-惠特尼U检验用于比较性别之间的连续变量。通过Pearson相关分析研究了各变量之间的关系。
结果:PCT是股骨头内最突出的骨结构。平均国安局,α,δ为126.85±5.85°,37.33±4.23°,和0.39±1.22毫米,分别,无显著性别差异(p>0.05)。皮尔逊相关分析显示,α与NSA之间存在很强的相关性(r=-0.689,p<0.001)。R和L-top(r=0.623,p<0.001),在δ和NSA之间观察到轻度相关(r=-0.487,p<0.001),R和L-底部(r=0.427,p<0.001)。重要的是,我们的研究建立了一种方法,准确定位PCT分布在真实的前后(AP)髋关节的X线照片,促进股骨近端固定手术中的精确螺钉放置。
结论:我们的研究为老年人群股骨近端PCT的分布提供了前所未有的见解。PCT在股骨近端的分布主要受解剖和几何因素的影响。如NSA和股骨头大小,而不是性别等人口因素。这些见解对内固定装置的设计和手术计划具有至关重要的意义。为髋部骨折治疗中螺钉的放置提供客观指导。
OBJECTIVE: As osteoporosis progresses, the primary compressive trabeculae (PCT) in the proximal femur remains preserved and is deemed the principal load-bearing structure that links the femoral head with the femoral neck. This study aims to elucidate the distribution patterns of PCT within the proximal femur in the elderly population, and to assess its implications for the development and optimization of internal fixation devices used in hip fracture surgeries.
METHODS: This is a retrospective cohort study conducted from March 2022 to April 2023. A total of 125 patients who underwent bilateral hip joint CT scans in our hospital were enrolled. CT data of the unaffected side of the hip were analyzed. Key parameters regarding the PCT distribution in the proximal femur were measured, including the femoral head\'s radius (R), the neck-shaft angle (NSA), the angle between the PCT-axis and the head-neck axis (α), the distance from the femoral head center to the PCT-axis (δ), and the lengths of the PCT\'s bottom and top boundaries (L-bottom and L-top respectively). The impact of gender differences on PCT distribution patterns was also investigated. Student\'s t-test or Mann-Whitney U test were used to compare continuous variables between genders. The relationship between various variables was investigated through Pearson\'s correlation analysis.
RESULTS: PCT was the most prominent bone structure within the femoral head. The average NSA, α, and δ were 126.85 ± 5.85°, 37.33 ± 4.23°, and 0.39 ± 1.22 mm, respectively, showing no significant gender differences (p > 0.05). Pearson\'s correlation analysis revealed strong correlations between α and NSA (r = -0.689, p < 0.001), and R and L-top (r = 0.623, p < 0.001), with mild correlations observed between δ and NSA (r = -0.487, p < 0.001), and R and L-bottom (r = 0.427, p < 0.001). Importantly, our study establishes a method to accurately localize PCT distribution in true anteroposterior (AP) radiographs of the hip joint, facilitating precise screw placement in proximal femur fixation procedures.
CONCLUSIONS: Our study provided unprecedented insights into the distribution patterns of PCT in the proximal femur of the elderly population. The distribution of PCT in the proximal femur is predominantly influenced by anatomical and geometric factors, such as NSA and femoral head size, rather than demographic factors like gender. These insights have crucial implications for the design of internal fixation devices and surgical planning, offering objective guidance for the placement of screws in hip fracture treatments.