一种评估髓内钉治疗股骨粗隆间骨折所致外侧壁破裂风险的影像学指标

发布时间：2018-04-14 03:26

本文选题：髋骨折 + 骨折固定术　；参考：《苏州大学》2015年硕士论文

【摘要】：目的探讨沿股骨颈上缘所作切线能否用来评估髓内钉治疗股骨粗隆间骨折所致外侧壁破裂的风险,并比较Intertan和Gamma3两种不同髓内钉对外侧壁影响的差异。方法回顾性分析2014年8月至2015年2月连续收治采用Intertan髓内钉或Gamma3钉治疗的56例的股骨粗隆间骨折患者影像学资料(其中有6例骨折线由股骨外侧肌嵴以下穿出),所有患者术前、术后均行X线和三维CT扫描。将50例骨折线由外侧肌嵴以上穿出患者资料按术中有无引起外侧壁破裂和髓内固定物不同分别进行分组。根据术中有无引起外侧壁破裂分成两组:外侧壁破裂组17例,平均年龄77岁(54-92);OTA31-A1型3例,OTA31-A2型14例。外侧壁未破裂组33例,平均年龄74岁(47-94);OTA31-A1型17例,OTA31-A2型16例。测量、记录并比较两组患者的骨折线穿出点至外侧肌嵴的长度、尖顶距。再应用ROC曲线求得区分外侧壁破裂与否的骨折线至外侧肌嵴长度的最佳临界值。还从这50例患者中按其男女比例分层抽得25例,测量、记录这25例患者对侧未骨折骨股骨颈上缘切线穿出点至股骨外侧肌嵴的长度,并与最佳临界值相比较。此外,还比较了Intertan和Gamma3两种不同髓内钉所致外侧壁破裂发生率的大小。结果术中外侧壁破裂组和未破裂组,骨折线穿出点至外侧肌嵴长度的平均值分别为(15.6±6.33)mm、(28.5±6.76)mm,差异有统计学意义(P=0.00000004);术中外侧壁破裂的发生率,OTA31-A2型骨折为46.7%(14/30)高于OTA31-A1型骨折的15%(3/20)(P=0.021);尖顶距平均值分别为(16.8±3.76)mm、(20.2±6.76)mm,差异亦有统计学意义(P=0.024);应用ROC曲线求得的骨折线穿出点至股骨外侧肌嵴长度的最佳临界值为20.445mm(灵敏度90.9%,特异度88.2%);25例对侧未骨折骨股骨颈上缘切线穿出点至股骨外侧肌嵴长度的平均值为(19.4±3.16)mm,与临界值20.445mm相近,两者间差异无统计学意义(P=0.109)。此外,Intertan髓内钉治疗组术中外侧壁的发生率为38.7%(12/31),Gamma3钉治疗组为26.3%(5/19),可经统计学分析,差异无统计学意义(P=0.369)。结论骨折线穿出点至股骨外侧肌嵴的长度可以用来评估髓内钉治疗股骨粗隆间骨折所致的外侧壁破裂风险,当该长度小于20.445mm时,术中易发生外侧壁破裂。临界值20.445mm所对应的位置可能就是沿股骨颈上缘所作切线穿出点处。Intertan与Gamma3两种不同髓内钉所致外侧壁破裂的发生不存在明显差异。
[Abstract]:Objective to evaluate the risk of lateral wall rupture caused by intramedullary nail in the treatment of intertrochanteric femoral fractures, and to compare the effects of Intertan and Gamma3 on the lateral wall of femoral intertrochanteric nail.Methods from August 2014 to February 2015, 56 patients with intertrochanteric fracture of femur treated with Intertan intramedullary nail or Gamma3 nail were retrospectively analyzed.X-ray and three-dimensional CT scans were performed after operation.The data of 50 patients with fracture line perforating from lateral muscle crest were divided into two groups according to whether there were rupture of lateral wall and intramedullary fixation.According to whether or not the lateral wall rupture was caused during the operation, 17 cases were divided into two groups: 17 cases in the lateral wall rupture group, with an average age of 77 years old and 3 cases with OTA31-A1 type OTA31-A2 type.There were 33 cases in the lateral wall unruptured group, with an average age of 74 years old, 17 cases of OTA31-A1 type OTA31-A1 type and 16 cases of OTA31-A2 type.To measure, record and compare the length of the fracture line from the point of entry to the lateral muscle crest and the apical distance between the two groups.Then the ROC curve was used to obtain the best critical value from the fracture line to the length of lateral muscle crest to distinguish whether the lateral wall was ruptured or not.25 of the 50 patients were stratified according to their ratio of male to female. The length of the superior margin tangential line of the contralateral unfractured femoral neck to the lateral femoral muscle crest was recorded and compared with the optimal critical value.In addition, the incidence of lateral wall rupture caused by two different intramedullary nails (Intertan and Gamma3) was compared.Results the lateral wall rupture group and the unruptured group,The average length of the muscle crest from the perforating point of fracture line to the lateral muscle crest was 15.6 卤6.33mm and 28.5 卤6.76mm. the difference was statistically significant, and the incidence of rupture of lateral wall was 46.7% 1430% (P < 0.05), which was higher than that of OTA31-A1 fracture (1533 / 20), and the mean apical distance was 16.8 卤3.76mm (20.2 卤6.76mm), respectively.The best critical value from the point of fracture line to the length of the lateral femur muscle crest obtained by ROC curve is 20.445mm (sensitivity 90.9mm, specificity 88.2mm).The mean value is 19.4 卤3.16mm, which is close to the critical value 20.445mm.There was no significant difference between the two groups.In addition, the incidence of intraoperative lateral wall in the Intertan intramedullary nailing group was 38.7 / 31g / 31.The incidence of the intraoperative lateral wall in the Gamma3 nail group was 26.310 / 19. The difference was not statistically significant (P < 0.05).Conclusion the length from the point of the fracture line to the lateral femoral crest can be used to evaluate the risk of lateral wall rupture caused by intramedullary nail in the treatment of intertrochanteric fracture. When the length is less than 20.445mm, the lateral wall rupture is easy to occur during the operation.The location corresponding to the critical value of 20.445mm may be that there is no significant difference in the occurrence of lateral wall rupture caused by two kinds of intramedullary nails, I. e. Intertan and Gamma3, along the superior margin of femoral neck.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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