对Garden指数作为股骨颈骨折复位质量评价标准的再认识

被引：28
|
作者：
蔡乐益
郭晓山
郑文浩
陈春慧
陈华
冯永增
机构：
[1] 温州医科大学附属第二医院骨科
来源：
中华创伤骨科杂志 | 2020年 / 22卷 / 03期
关键词：
股骨颈骨折; 复位; Garden指数; 旋转移位;
D O I：
暂无
中图分类号：
R6 [外科学];
学科分类号：
1002 ; 100210 ;
摘要：
目的探讨Garden指数能否判断股骨颈骨折的旋转移位。方法取5具10侧健康股骨近端尸体标本, 男3具, 女2具;死亡年龄为45～70岁。于股骨头中心置入1枚直径为2.0 mm的克氏针, 垂直于股骨颈中部截骨, 在截骨处远端骨面标明旋转角度。在每侧标本上依次进行旋前及旋后0°、10°、20°、30°、40°、50°、70°、90°操作, 并摄标本正、侧位X线片, 利用影像归档和通信系统测量Garden指数, 比较不同旋转角度下的正位、侧位Garden指数。同时观察在不同旋转角度下股骨头小凹面积的变化规律。结果从0°至旋前30°或旋后30°的过程中, 正位、侧位Garden指数无明显变化, 差异均无统计学意义(P>0.05), 且数值均>155°。从旋前40°至旋前90°的过程中, 正位Garden指数分别为152.36°±1.41°、146.04°±1.64°、143.95°±0.60°、141.73°±0.60°, 侧位Garden指数分别为172.54°±0.86°、168.57°±0.98°、157.18°±1.17°、156.47°±1.63°, 不同旋转角度之间比较差异均有统计学意义(P<0.05)。从旋后40°至旋后90°的过程中, 正位Garden指数分别为151.67°±1.06°、147.32°±1.82°、142.77°±0.75°、139.88°±1.48°, 侧位Garden指数分别为172.28°±0.79°、166.76°±1.02°、155.67°±1.74°、154.16°±1.27°, 不同旋转角度之间比较差异均有统计学意义(P< 0.05)。随着旋前角度的增大, 股骨头小凹面积逐渐减少;随着旋后角度的增大, 股骨头小凹面积逐渐增大。结论在0°～30°的旋前或旋后范围内, Garden指数无法准确判断股骨颈骨折复位时的旋转移位。股骨头小凹面积的变化可以辅助判断股骨颈骨折的旋转移位。
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页码：232 / 233-234-235-236-237
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