본문 바로가기
KERD
논문KCI 등재

Assessment of the Bone Mineral Density and Microstructure of the Human Femoral Head according to Different Tip-apex Distances Can Guide the Treatment of Intertrochanteric Hip Fractures

1

조회

0

다운로드

0

인용

0

참고문헌

키워드

초록

Purpose: We analyzed the microstructure and bone mineral density (BMD) of the trabecular bone in the femoral head of patients with osteoporosis. Materials and Methods: Sixteen femoral heads with osteoporotic femoral neck fractures underwent microcomputed tomography scanning. In each tip-apex distance (TAD) of 15, 20, and 25 mm, five regions of interest (ROIs) were extracted from the central, anterior, posterior, superior, and inferior sections. A total of 15 ROIs were extracted from TADs of 15, 20, and 25 mm. The measurement parameters included BMD, percent bone volume: bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), structural model index (SMI), and degree of anisotropy (DOA). Results: The lowest BMD and BV/TV values were observed in the inferior region and differed significantly from those in other regions (P<0.05). Lower Tb.Th and Tb.N values were observed in the inferior region compared with those in the central region (P<0.05). The highest SMI value was observed in the inferior region (P<0.05). With TAD of 15 and 20 mm, the DOA values in the inferior region were lower than those in the anterior region (P<0.05). Lower BMD and BV/TV values were observed in the anterior, central, and inferior regions of TAD of 15 mm compared with those in the corresponding regions of TAD of 25 mm (P<0.05). Conclusion: Positioning the lag screw between TAD of 20 to 25 mm and in the inferior region is recommended, and TAD of less than 15 mm is not recommended.

Abstract

Purpose: We analyzed the microstructure and bone mineral density (BMD) of the trabecular bone in the femoral head of patients with osteoporosis. Materials and Methods: Sixteen femoral heads with osteoporotic femoral neck fractures underwent microcomputed tomography scanning. In each tip-apex distance (TAD) of 15, 20, and 25 mm, five regions of interest (ROIs) were extracted from the central, anterior, posterior, superior, and inferior sections. A total of 15 ROIs were extracted from TADs of 15, 20, and 25 mm. The measurement parameters included BMD, percent bone volume: bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), structural model index (SMI), and degree of anisotropy (DOA). Results: The lowest BMD and BV/TV values were observed in the inferior region and differed significantly from those in other regions (P<0.05). Lower Tb.Th and Tb.N values were observed in the inferior region compared with those in the central region (P<0.05). The highest SMI value was observed in the inferior region (P<0.05). With TAD of 15 and 20 mm, the DOA values in the inferior region were lower than those in the anterior region (P<0.05). Lower BMD and BV/TV values were observed in the anterior, central, and inferior regions of TAD of 15 mm compared with those in the corresponding regions of TAD of 25 mm (P<0.05). Conclusion: Positioning the lag screw between TAD of 20 to 25 mm and in the inferior region is recommended, and TAD of less than 15 mm is not recommended.

참고문헌 (22)

  1. Keene GS, "Mortality and morbidity after hip fractures", BMJ, 307, pp.1248~1250 (1993)
  2. Bojan AJ, "Critical factors in cut-out complication after Gamma Nail treatment of proximal femoral fractures", BMC Musculoskelet Disord, 14, pp.1~ (2013)
  3. Baumgaertner MR, "The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip", J Bone Joint Surg Am, 77, pp.1058~1064 (1995)
  4. De Bruijn K, "Reliability of predictors for screw cutout in intertrochanteric hip fractures", J Bone Joint Surg Am, 94, pp.1266~1272 (2012)
  5. Andruszkow H, "Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures", Int Orthop, 36, pp.2347~2354 (2012)
  6. Uemura K, "The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures", J Orthop Surg(Hong Kong), 26, pp.2309499018778325~ (2018)
  7. Konya MN, "Numerical optimization of the position in femoral head of proximal locking screws of proximal femoral nail system; biomechanical study", Balkan Med J, 34, pp.425~431 (2017)
  8. Zhou JQ, "Failure of PFNA : helical blade perforation and tip-apex distance", Injury, 43, pp.1227~1228 (2012)
  9. Goffin JM, "The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw : a subject-specific finite element study", J Orthop Res, 31, pp.596~600 (2013)
  10. Kane P, "Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement", Clin Orthop Relat Res, 472, pp.2492~2498 (2014)
  11. Kuzyk PR, "Femoral head lag screw position for cephalomedullary nails : a biomechanical analysis", J Orthop Trauma, 26, pp.414~421 (2012)
  12. Lee CH, "Impact of tip-apex distance and femoral head lag screw position on treatment outcomes of unstable intertrochanteric fractures using cephalomedullary nails", J Int Med Res, 46, pp.2128~2140 (2018)
  13. Ab-Lazid R, "Pullout strength of cancellous screws in human femoral heads depends on applied insertion torque, trabecular bone microarchitecture and areal bone mineral density", J Mech Behav Biomed Mater, 40, pp.354~361 (2014)
  14. Harrigan TP, "Limitations of the continuum assumption in cancellous bone", J Biomech, 21, pp.269~275 (1988)
  15. Davis TR, "Intertrochanteric femoral fractures. Mechanical failure after internal fixation", J Bone Joint Surg Br, 72, pp.26~31 (1990)
  16. Kukla C, "The standard Gamma nail : a critical analysis of 1, 000 cases", J Trauma, 51, pp.77~83 (2001)
  17. Nordin S, "Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur", Med J Malaysia, 56(Suppl D), pp.12~17 (2001)
  18. Simpson AH, "Sliding hip screws : modes of failure", Injury, 20, pp.227~231 (1989)
  19. Utrilla AL, "Trochanteric gamma nail and compression hip screw for trochanteric fractures : a randomized, prospective, comparative study in 210elderly patients with a new design of the gamma nail", J Orthop Trauma, 19, pp.229~233 (2005)
  20. Wolfgang GL, "Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation", Clin Orthop Relat Res, (163), pp.148~158 (1982)
  21. Hsueh KK, "Risk factors in cutout of sliding hip screw in intertrochanteric fractures : an evaluation of 937 patients", Int Orthop, 34, pp.1273~1276 (2010)
  22. Jenkins PJ, "A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures", Acta Orthop, 84, pp.453~459 (2013)

관련 논문AI추천

이 간행물의 다른 논문 (7건)