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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 21  |  Page : 2524-2530

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population


1 Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, China
2 Department of Nosocomial Infection, Anqing Hospital, Anhui Medical University, Anqing, Anhui 246003, China
3 Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051; Chinese Academy of Engineering, Beijing 100088, China

Correspondence Address:
Dr. Ying-Ze Zhang
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Key Laboratory of Biobmechanics of Hebei Province, Shijiazhuang, Hebei 050051; Chinese Academy of Engineering, Beijing 100088
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.244118

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Background: Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods: We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results: Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001). Conclusions: We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

 

 Abstract in Chinese

中国老年人群中股骨颈骨折与股骨转子间骨折的股骨近端几何参数风险因素的比较

摘要

背景:很少有研究调查不同类型的髋部患者股骨近端几何形态参数和危险因素的差异性,尤其是在中国老年人群中开展这种研究十分罕见。本研究旨在探讨股骨颈骨折和股骨转子间骨折患者的股骨近端几何形态参数的差异性,为设计符合国人的个体化定制型假体提供依据,并为股骨近端的精准重建提供指导。

方法:采用回顾性研究的方法,对河北医科大学第三医院2017年1月到2017年12月间198例老年髋部骨折患者的临床资料进行研究,其中男性44例,女性154例,股骨颈骨折患者101例,股骨转子间骨折患者97例。通过医学图像阅读软件(RadiAnt Dicom Viewer)测量每位患者的颈干角(Neck Shaft Angle, NSA),中心边缘角(Center Edge Angle, CEA),股骨头直径(Femoral Head Diameter, FHD),股骨颈直径(Femoral Neck Diameter, FND),股骨颈轴长(Femoral Neck Axial Length, FNAL),髋轴长(Hip Axial Length, HAL)和股骨干直径(Femoral Shaft Diameter, FSD)七个形态参数,并记录患者年龄,性别和骨折部位。采用t检验对连续变量进行比较,卡方检验分析分类变量以及使用多重Logistic 回归分析比较股骨颈骨折患者和股骨转子间骨折的股骨近端形态参数间的差异,并比较不同性别的髋部骨折患者几何形态参数的差异。

结果:两组不同髋部骨折类型的骨折患者的NSA,CEA,FND和FNAL有显著的统计学差异(P<0.001, P<0.001, P=0.027和P<0.001)。NSA为股骨颈骨折的危险因素(OR 0.70, P<0.001),CEA和FNAL为股骨转子间骨折的危险因素(OR 1.15, 1.17, P均<0.001)。FND为股骨转子间骨折的保护因素 (OR 0.74, P<0.001)。

结论:我们的研究证实了不同类型的髋部骨折患者股骨近端几何形态参数存在着差异性,同时髋部几何形态参数存在着性别差异。在骨折内固定及髋关节置换术中假体选择方面应考虑到不同髋部骨折类型和不同性别的股骨近端几何形态参数的差异性。同时可指导设计符合国人的个体化定制型假体,并对老年髋部骨折患者股骨近端的精准重建提供依据。



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