摘要
目的 通过对股骨颈进行不同位置和不同角度的X线投照,总结股骨近端关键部位及骨折线显示规律,并获取最佳投照方式.方法 按纳入及排除标准选取天津医科大学解剖教研室提供的6根股骨标本,分别制作完整股骨颈模型、锡线模型和骨折模型,并依次进行X线投照.锡线模型是以Pauwells角为依据,用锡线缠绕制作3种骨折模型（Pau-wells角30°、50°和70°）;骨折模型是用钢锯锯断,制作同锡线模型一样的3组骨折模型.投照方式包括不同位置和不同角度,不同投照位置包括：与股骨干平行、与股骨干垂直、与股骨颈平行、与股骨颈垂直;不同投照角度包括：头侧40°、头侧300、头侧20°、头侧15°、头侧10°、头侧5°、垂直0°、足侧5°、足侧10°、足侧15°、足侧20°、足侧30°、足侧40°.对完整股骨颈投照后观察股骨头、颈部关键部位（主压力性和主张力性骨小梁、小转子、转子间线、股骨颈长度、股骨头外形）的影像学特点,总结其显示规律,并分别获取其最佳显示位置.对于锡线模型和骨折模型通过不同位置和角度的投照,探讨骨折线显示的最佳投照角度和位置.结果 完整股骨颈模型投照结果显示：小转子最佳投照方式为与股骨干垂直,随足侧偏转显示逐渐增大;压力性和张力性骨小梁最佳投照方式为与股骨干平行并向头侧偏转10°,随着角度向两侧偏转渐显示不清;转子间线最佳投照方式为与股骨干平行或与股骨干垂直,两者无明显区别,但在与股骨干垂直位置随偏转角度增大其与颈基底部渐重合;股骨头颈部外形随管球向两侧偏转,股骨头渐变形.锡线模型投照结果显示：Pauwells角30°时骨折线最佳投照方式为与股骨干平行并头侧偏转20°;Pauwells角50°时骨折线最佳投照方式为与股骨干平行并头侧偏转5°;Pau-wells角70°时骨折线最佳投照方式为与股骨干平行并头侧偏转10°.骨折模型骨折线最佳投照方式与锡线模型相同.结论 股骨近端的关键解剖结构以及不同Pauwells角分型的股骨颈骨折线各有其最佳的投照位置和角度,影像科医生可根据股骨颈骨折的不同类型有针对性进行更加精确地投照.
Objective To find out the display rules of the key part of the proximal femur and fracture line and obtain the best viewing position and angle by placing the femoral neck at different positions and different angles through X-ray.Methods Six dry specimens of cadaveric femur were from Department of Anatomy,Tianjin Medical University.Three models of complete femoral neck model,tin line fracture model and steel saw fracture model were made respectively.The tin line fracture model was based on the Pauwells angle,using the tin wire（1mm） wrapped around the femoral necks to make three kinds of fracture models （Pauwells angle 30°,50° and 70°）;steel saw fracture model was made by hacksaw,then reposition in situ,to make three kinds of fracture models same as the tin line fracture model.The projection manner included different positions and different angles,different projection positions include：parallel with the femoral shaft,perpendicular to the femoral shaft,parallel to the femoral neck and perpendicular to the femoral neck;different projection angles included：from 40°,30°,20°,15°,10° and 5° in the head side to 5°,10°,15 °,20 °,30 °and 40° in the foot side and vertical angle 0°.For the complete femoral neck model,we observed the imaging characteristics of the key parts of the femoral head and neck （tension trabecular bone and pressure trabecular bone;lesser trochanter;intertrochanteric line;length of neck of femur and femoral head shape）,looking for the display rules,and obtained the best viewing position.For tin line fracture model and steel saw fracture model,we tried to find the best display angle and position by the different projection position and angle.Results The results of complete femoral neck model：Lesser trochanter：in perpendicular to the femoral shaft position showed the best,gradually increased with the foot side deflection;tension trabecular bone and pressure trabecular bone：in parallel with the femoral shaft position 10°on the head side;intertrochanteric line：no difference between parallel with the femoral shaft with perpendicular to the femoral shaft;Femoral neck shape：deflect to both sides,head of femur was out of shape.The results of tin line fracture model：the Pauwells angle 30° model showed the best position in parallel with the femoral shaft position 20° on the head side;the Pauwells angle 50° model showed the best position in parallel with the femoral shaft position 5° on the head side;the Pauwells angle 70° model showed the best position in parallel with the femoral shaft position 10° on the head side.The results of steel saw fracture model were the same with the tin line fracture model.Conclusion There was the best viewing angles and positions for the key anatomy of the proximal femur and different Pauwells angle classification of femoral neck fracture.The image doctor could make more accurate projection,according to the different types of femoral neck fracture.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第12期735-745,共11页
Chinese Journal of Orthopaedics
基金
国家自然科学基金项目（81572154）
关键词
股骨颈骨折
放射摄影术
诊断
Femoral neck fractures
Radiography
Diagnosis
