股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究

刘力铭; 雷凯; 范华全; 陈欣; 杨柳; 郭林

doi:10.16016/j.1000-5404.202006166

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股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究

临床医学 | 更新时间：2026-01-09

- 股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究
- Differences in femoral neck shaft angles between anteroposterior X-ray and 3-dimensional CT reconstruction images: report of 265 cases
- 第三军医大学学报 2020年42卷第21期页码：2134-2140
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院关节外科中心
- 作者简介：
  
  [郭林，E-mail: guolin6212@163.com GUO Lin, E-mail: guolin6212@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202006166
  中图分类号： R322.71;R681.8;R813
- 收稿：2020-06-18，
  
  修回：2020-08-20，
  
  纸质出版：2020-11-15
- 稿件说明：
移动端阅览
刘力铭, 雷凯, 范华全, 等. 股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究[J]. 第三军医大学学报, 2020,42(21):2134-2140.

Liming LIU, Kai LEI, Huaquan FAN, et al. Differences in femoral neck shaft angles between anteroposterior X-ray and 3-dimensional CT reconstruction images: report of 265 cases[J]. Journal of Third Military Medical University, 2020, 42(21): 2134-2140.
刘力铭, 雷凯, 范华全, 等. 股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究[J]. 第三军医大学学报, 2020,42(21):2134-2140. DOI： 10.16016/j.1000-5404.202006166.

Liming LIU, Kai LEI, Huaquan FAN, et al. Differences in femoral neck shaft angles between anteroposterior X-ray and 3-dimensional CT reconstruction images: report of 265 cases[J]. Journal of Third Military Medical University, 2020, 42(21): 2134-2140. DOI： 10.16016/j.1000-5404.202006166.

摘要

目的

探讨股骨颈干角在前后位X线平片与CT三维重建图像上的差异及其主要相关因素。

方法

通过陆军军医大学第一附属医院电子病历系统回顾性收集2016年8月至2018年6月于关节外科中心住院患者资料265例(265侧下肢)。判定其股骨颈干角在前后位X线平片与CT三维重建图像上的差异性。通过记录其年龄、性别、BMI、左右侧别，测量其髋膝踝角、股骨干弓形角、股骨扭转角、股骨远端机械轴外侧角、股骨干长度，并建立统计学模型，筛选导致其差异的最主要因素。同时设立对照组及试验组，通过1:1倾向性评分匹配验证导致差异的最主要相关因素。

结果

股骨颈干角X线平片测量值(128.02±6.26)°与其CT三维图像测量值(124.22±6.45)°具有统计学差异(

0.001)，且差异大于3°的占比高达56.6%。多重线性回归模型(

0.001，调整

=0.747)显示股骨扭转角(标化系数=-0.233，

0.001)是其差异的最主要相关因素。

结论

股骨颈干角在前后位X线平片与CT三维重建图像上存在显著差异，股骨扭转角是导致差异的主要相关因素，较大的股骨颈外旋扭转会伴有股骨颈干角的X线测量结果偏大。

Abstract

Objective

To explore the differences in measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image

and investigate the main related factors that lead to the differences.

Methods

The clinical data of 265 lower limbs from 265 patients hospitalized in our center from August 2016 to June 2018 were retrospectively collected from the electronic medical record system of our hospital. The femoral neck shaft angle was measured on the anteroposterior X-ray films and 3-dimensional CT reconstruction images

and the difference was tested. Age

gender

BMI

left and right difference

hip-knee-ankle angle

femoral bowing angle

femoral torsion angle

mechanical lateral distal femoral angle and femoral shaft length were included to establish a statistical model to screen the most important factors leading to the difference. Finally

a control group and an experimental group were set up through the 1:1 propensity score matching to verify the the most important factors.

Results

The femoral neck shaft angle was (128.02±6.26)° on the anteroposterior X-ray films and (124.22±6.45)° on the 3-dimensional CT reconstruction images

and statistical difference was found between them (

0.001)

with a difference greater than 3° (accounting for 56.6% of the patients). The established multiple linear regression model (

0.001

adjusted

=0.747) showed that femoral torsion angle (standardized regression coefficient=-0.233

0.001) was the most important factor of the difference.

Conclusion

There is a difference in the measurement result of femoral neck shaft angle between anteroposterior X-ray film and 3-dimensional CT reconstruction image. Femoral torsion angle is the most important factor. Larger femoral extorsion angle causes larger femoral neck shaft angle measured on the anteroposterior X-ray film.

关键词

Keywords

references

TEO P C, KASSIM A Y, THEVARAJAN K. A 45-degree radiographic method for measuring the neck shaft angle and anteversion of the femur: a pilot study[J]. J Orthop Surg (Hong Kong), 2013, 21(3): 340-346. DOI:10.1177/230949901302100316.

RIPAMONTI C, LISI L, AVELLA M. Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density[J]. Br J Radiol, 2014, 87(1037): 20130358. DOI:10.1259/bjr.20130358.

BIZDIKIAN A J, ASSI A, BAKOUNY Z, et al . Validity and reliability of different techniques of neck-shaft angle measurement[J ] . Clin Radiol, 2018, 73(11): 984.e1-984.e9.DOI:10.1016/j.crad.2018.06.006.

YI L H, LI R, ZHU Z Y, et al . Anatomical study based on 3D-CT image reconstruction of the hip rotation center and femoral offset in a Chinese population: preoperative implications in total hip arthroplasty[J ] . Surg Radiol Anat, 2019, 41(1): 11 7-124. DOI:10.1007/s00276-018-2143-9.

GNUDI S, SITTA E, PIGNOTTI E. Prediction of incident hip fracture by femoral neck bone mineral density and neck-shaft angle: a 5-year longitudinalstudy in post-menopausal females[J]. Br J Radiol, 2012, 85(1016): e467-e473. DOI:10.1259/bjr/57130600.

WRIGHT D, WHYNE C, HARDISTY M, et al . Functional and anatomic orientation of the femoral head[J ] . Clin Orthop Relat Res, 2011, 469(9): 2583-2589. DOI:10.1007/s11999-010-1754-1.

BULLER L T, ROSNECK J, MONACO F M, et al . Relationship between proximal femoral and acetabular alignment in normal hip joints using 3-dimensional computed tomography[J ] . Am J Sports Med, 2012, 40(2): 367-375. DOI:10.1177/0363546511424390.

曹梦琦, 马俊, 黄泽宇, 等.股骨机械-解剖轴夹角与颈干角、偏心距的相关性[J].中国矫形外科杂志, 2014, 22(15): 1397-1401.

CAO M Q, MA J, HUANG Z Y, et al . Correlation of femoral mechanical-anatomical angle with neck- shaft angle and offset[J ] . Orthop J China, 2014, 22(15): 1397-1401.

SOODMAND E, ZHENG G, STEENS W, et al . Surgically relevant morphologica l parameters of proximal human femur: a statistical analysis based on 3D reconstruction of CT data[J ] . Orthop Surg, 2019, 11(1): 135-142. DOI:10.1111/os.12416.

JIANG N, PENG L, AL-QWBANI M, et al . Femoral version, neck-shaft angle, and acetabular anteversion in Chinese Han population: a retrospective analysis of 466 healthy adults[J ] . Medicine (Baltimore), 2015, 94(21): 1-9. DOI:10.1097/MD.0000000000000891.

皮益刚, 赵耀超, 王万春, 等. 500例湖南地区股骨近端形态样本测量分析[J].中南大学学报(医学版), 2013, 38(9): 925-930.

PI Y G, ZHAO Y C, WANG W C, et al . Measurement of proximal femoral morphology and analysis of 500 cases in Hunan Province[J ] . J Central South Univ Med Sci, 2013, 38(9): 925-930.

卢仲琳, 曹志强, 高国梁, 等.股骨假体颈干角、前倾角变化对全髋关节置换术后预后的影响[J].中国现代医学杂志, 2018, 28(11): 68-74.

LU Z L, CAO Z Q, GAO G L, et al . Effect of post-operative changes of neck-shaft angle and femoral component anteversion on clinical outcome following uncemented total hip arthroplasty[J ] . Chin J Mod Med, 2018, 28(11): 68-74.

汪轶平, 张恒辉, 王燎, 等.股骨近端解剖参数的自动化三维测量[J].医用生物力学, 2016, 31(1): 1-7.

WANG Y P, ZHANG H H, WANG L, et al . Automated three-dimensional measurement on anatomic parameters of proximal femur[J ] . J Med Biomech, 2016, 31(1): 1-7.

朱建炜, 董启榕, 刘璠, 等.正常国人股骨近端解剖参数的研究[J].苏州大学学报(医学版), 2008, 28(4): 582-585.

ZHU J W, DONG Q R, LIU F, et al . Study on the proximal femoral parameters in the healthy Chinese[J ] . J Soochow Univ Med Sci Ed, 2008, 28(4): 582-585.

PALEY D. Principles of deformity correction[M]. Heidelberg: Springer, 2002: 1-60.

CUOMO A V, FEDORAK G T, MOSELEY C F. A practical approach to determining the center of the femoral head in subluxated and dislocated hips[J]. J Pediatr Orthop, 2015, 35(6): 556-560. DOI:10.1097/BPO.00000000000 00281.

LASAM M P, LEE K J, CHANG C B, et al . Femoral lateral bowing and Varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans[J ] . Clin Orthop Relat Res, 2013, 471(5): 1472-1483. DOI:10.1007/s11999-012-2618-7.

LIU T, WANG C Y, XIAO J L, et al . Three-dimensional reconstruction method for measuring the knee Valgus angle of the femur in northern Chinese adult s[J ] . J Zhejiang Univ Sci B, 2014, 15(8): 720-726. DOI:10.1631/jzus.B1400019.

KIM J M, HONG S H, KIM J M, et al . Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape[J ] . Knee Surg Sports Traumatol Arthrosc, 2015, 23(7): 1936-1942. DOI:10.1007/s00167-014-3006-5.

MULLAJI A B, MARAWAR S V, MITTAL V. A comparison of coronal plane axial femoral relationships in Asian patients with Varus osteoarthritic knees and healthy knees[J]. J Arthroplasty, 2009, 24(6): 861-867. DOI:10.1016/j.arth.2008.05.025.

BOISGARD S, MOREAU P E, DESCAMPS S, et al . Computed tomographic study of the posterior condylar angle in arthritic knees: its use in the rotational positioning of the femoral implant of total knee prostheses[J ] . Surg Radiol Anat, 2003, 25(3/4): 330-334. DOI:10.1007/s00276-003-0144-8.

HAN Q, ZHANG A B, WANG C Y, et al . Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle[J ] . Medicine (Baltimore), 2019, 98(45): e17727. DOI:10.1097/MD.0000000000017727.

LOHMAN M, TALLROTH K, KETTUNEN J A, et al . Changing from analog to digital images: does it affect the accuracy of alignment measurements of the lower extremity?[J ] . Acta Orthop, 2011, 82(3): 351-355. DOI:10.3109/17453674.2011.570670.

WIDMER K H, MAJEWSKI M. The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty[J]. Clin Biomech (Bristol, Avon), 2005, 20(7):723-728.DOI:10.1016/j.clinbiomech.2005.04.003.

GUENOUN B, ZADEGAN F, AIM F, et al . Reliability of a new method for lower-extremity measurements based on stereoradiographic three-dimensional reconstruction[J ] . Orthop Traumatol Surg Res, 2012, 98(5): 506-513. DOI:10.1016/j.otsr.2012.03.014.

ANASTOPOULOS G, CHISSAS D, DOUROUNTAKIS J, et al . Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing[J ] . Injury, 2010, 41(3): 300-305. DOI:10.1016/j.injury.2009.09.007.

BONNEAU N, LIBOUREL P A, SIMONIS C, et al . A three-dimensional axis for the study of femoral neck orientation[J ] . J Anat, 2012, 221(5): 465-476. DOI:10.1111/j.1469-7580.2012.01565.x.

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