目的 评估骨盆入射角(pelvic incidence,PI)、髋关节偏转角(hip deflection angle,HDA)以及联合偏转角(combined deflection angle,CDA)与股骨颈骨折后股骨头坏死(osteonecrosis of the femoral head,ONFH)发生的相关性,探讨股骨颈骨折后早期预测ONFH发生的指标.方法 以2018年12月-2020年12月接受空心螺钉内固定术的股骨颈骨折患者为研究对象,其中208例符合选择标准纳入研究,以是否发生ONFH分为坏死组和未坏死组.基于术前骨盆正位、患侧髋关节轴位X线片测量PI、HDA及CDA,并比较两组间差异.利用受试者操作特征曲线(receiver operating characteristic curve,ROC)评价上述影像学指标预测ONFH的价值.结果 纳入研究的208例患者中,随访期间84例发生ONFH(坏死组),124例未发生ONFH(未坏死组).未坏死组男59例,女65例;年龄18～86岁,平均53.9岁;随访时间18～50个月,平均33.2个月.坏死组男37例,女47例;年龄18～76岁,平均51.6岁;随访时间8～45个月,平均22.1个月.坏死组PI、HDA及CDA均大于未坏死组,差异有统计学意义(P＜0.05).ROC曲线分析示PI临界值为19.82°(敏感性40.5％,特异性86.3％,P＜0.05),HDA临界值为20.94°(敏感性77.4％,特异性75.8％,P＜0.05),CDA临界值为39.16°(敏感性89.3％,特异性83.1％,P＜0.05).结论 PI、HDA及CDA与股骨颈骨折后ONFH发生相关,其中CDA可以作为重要参考指标,CDA≥39.16°患者术后发生ONFH风险更高.
Correlation analysis between combined deflection angle and osteonecrosis of femoral head after femoral neck fracture
Objective To evaluate the correlation between pelvic incidence(PI)angle,hip deflection angle(HDA),combined deflection angle(CDA)and osteonecrosis of the femoral head(ONFH)after femoral neck fracture,in order to explore early predictive indicators for ONFH occurrence after femoral neck fracture.Methods A study was conducted on patients with femoral neck fractures who underwent cannulated screw internal fixation between December 2018 and December 2020.Among them,208 patients met the selection criteria and were included in the study.According to the occurrence of ONFH,the patients were allocated into ONFH group and non-NOFH group.PI,HDA,and CDA were measured based on the anteroposterior X-ray films of pelvis and axial X-ray films of the affected hip joint before operation,and the differences between the two groups were compared.The receiver operating characteristic curve(ROC)was used to evaluate the value of the above imaging indicators in predicting the occurrence of ONFH.Results Among the 208 patients included in the study,84 patients experienced ONFH during follow-up(ONFH group)and 124 patients did not experience ONFH(non-ONFH group).In the non-ONFH group,there were 59 males and 65 females,the age was 18-86 years(mean,53.9 years),and the follow-up time was 18-50 months(mean,33.2 months).In the ONFH group,there were 37 males and 47 females,the age was 18-76 years(mean,51.6 years),and the follow-up time was 8-45 months(mean,22.1 months).The PI,HD A,and CD A were significantly larger in the ONFH group than in the non-ONFH group(P＜0.05).ROC curve analysis showed that the critical value of PI was 19.82°(sensitivity of 40.5％,specificity of 86.3％,P＜0.05);the critical value of HDA was 20.94°(sensitivity of 77.4％,specificity of 75.8％,P＜0.05);and the critical value of CDA was 39.16°(sensitivity of 89.3％,specificity of 83.1％,P＜0.05).Conclusion There is a correlation between PI,HDA,CDA and the occurrence of ONFH after femoral neck fracture,in which CDA can be used as an important reference indicator.Patients with CDA≥39.16° have a higher risk of ONFH after femoral neck fracture.
Femoral neck fracturecombined deflection angleprediction of osteonecrosis of the femoral head
万方数据
维普
