Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section&nbsp;

ZHU Qiu-Liang; YU Xiang-Ping; MA Jun; CHEN Yun-Yun; LIN Fang; RUAN Wen-Bin

doi:10.16098/j.issn.0529-1356.2023.05.013

PDF(9523 KB)

Acta Anatomica Sinica ›› 2023, Vol. 54 ›› Issue (5) : 586-592. DOI: 10.16098/j.issn.0529-1356.2023.05.013

Anatomy

Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section

ZHU Qiu-liang^1* YU Xiang-ping² MA Jun¹ CHEN Yun-yun³ LIN Fang³RUAN Wen-bin¹

Author information +

History +

Abstract

Objective To investigate the appropriate X-ray angle which image can represent total proximal of femur according to the anatomic shape of the femoral neck section. Methods The anatomic parameter of the femoral neck section was observed and measured. Found the femoral neck was contained with three main surfaces of anterior surface, posterosuperior surface and posteroinferior surface. A model of surface fluoroscopy has been made by covering aluminum foil papers on the three surfaces of femoral neck. Taking the midpoint of the femoral neck as the fluoroscopy center, the C-arm was rotated at an interval of 10° between 0° and 170°, and the three aluminum foil paper models were taken for X-ray projection respectively. The X-ray angle with the smallest image of aluminum foil paper was taken as the appropriate X-ray angle of the surface. A penetrating model of the femoral neck internal fixation was made of three Kirschner wires penetrating through the anterior, posterosuperior and posteroinferior surfaces of femoral neck. The images of the penetrating Kirschner wires were observed through the traditional anteroposterior, lateral view and the three appropriate X-ray angle views obtained from the above test. Results The length of the three main surfaces accounts for 80.95% of the circumference of the femoral neck. The anterior surface coronal angle was 18°, the posterosuperior surface coronal angle was 65°, and the posteroinferior surface coronal angle was 165°. The Appropriate X-ray angle of the three surfaces were 20°, 70° and 170° respectively. In the images of the three appropriate X-ray angles, the penetrating Kirschner wires of anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be clearly observed respectively, while the penetrating Kirschner wire could not be completely found in the traditional anteroposterior and lateral images. Conclusion Traditional anteroposterior and lateral fluoroscopy can not accurately display the three-dimensional structure of femoral neck. By increasing the appropriate X-ray angle of 20°, 70° and 170°, the reduction quality and bony violation from internal fixation implants on the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be observed respectively.

Key words

Femoral neck / Section / Internal fixation / C-ram / Fluoroscopy / Anatomy / Human

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

ZHU Qiu-liang YU Xiang-ping MA Jun CHEN Yun-yun LIN Fang RUAN Wen-bin. Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section [J]. Acta Anatomica Sinica. 2023, 54(5): 586-592 https://doi.org/10.16098/j.issn.0529-1356.2023.05.013

References

［1］Zhang ChQ，Wang Q，Qiu GL, et al. Three-dimensional interactive reduction of femoral neck and shaft for treatment of irreducible femoral neck fracture［J］. Chinese Journal of Trauma, 2014,30(3):217-220.(in Chinese)

张长青, 王清, 邱国良, 等. 股骨头、干三维互动复位技术治疗难复位性股骨颈骨折［J］. 中华创伤杂志, 2014,30(3): 217-220.

［2］Cai LY, Guo XSh, Zheng WH, et al. Re-evaluation of Garden indexes as a criterion for reduction of femoral neck fracture: a cadaveric study［J］. Chinese Journal of Orthopaedic Trauma, 2020,22(3):232-237. (in Chinese)

蔡乐益, 郭晓山, 郑文浩，等. 对Garden指数作为股骨颈骨折复位质量评价标准的再认识［J］.中华创伤骨科杂志，2020，22（3）：232-237.

［3］Liu GH, Mao YJ, Zha Y, et al. Clinical study to the cannulated screws with fluoroscopy in the operation of femoral neck fractures［J］. Chinese Journal of Surgery, 2010,48(14):1101-1105. (in Chinese)

刘国会, 毛玉江, 查晔, 等. 股骨颈骨折术中透视判断空心钉位置的临床研究［J］. 中华外科杂志，2010，48（14）：1101-1105.

［4］Zhu QL, Xu B. Distinguish differentiation between femora neck torsion angle and femora neck anteversion in description and clinic value by eyes［J］. Acta Anatomica Sinica, 2016,47(5):658-662. (in Chinese)

朱求亮，许斌. 肉眼直观区别股骨颈扭转角与前倾角［J］. 解剖学报，2016,47(5):658-662.

［5］Trikha V, Kumar A, Mittal S，et al. Risk of bony violation with standard triple screw configurations for fixation of femoral neck fractures: a preliminary computed tomography based analysis［J］. J Clin Orthop Trauma, 2020,11(4):s546-552.

［6］Hofmann JC, Kellam J, Kumaravel M, et al. Is the cranial and posterior screw of the “inverted triangle” configuration for femoral neck fractures safe［J］? J Orthop Trauma, 2019,33(7):331-334.

［7］Zhang YQ, Chang SM, Huang YG, et al. The femoral neck safe zone: a radiographic simulation study to prevent cortical perforation with multiple screw insertion［J］. J Orthop Trauma, 2015,29(5):e178-182.

［8］Li X, Chen Zh, Yang HCh. Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures［J］. Chinese Journal of Orthopaedic Trauma, 2011,13(1):25-28. (in Chinese)

李欣, 陈仲, 杨洪昌. 股骨颈骨折闭合复位的实际效果分析［J］. 中华创伤骨科杂志，2011，13（1）：25-28.

［9］Aibinder WR, Yuan BJ, Cross WW 3rd, et al. Sequential fluoroscopic rollover images reliably identify “in-out-in” posterosuperior screws during percutaneous fixation of femoral neck fractures［J］. Eur J Orthop Surg Traumatol, 2020,30(6):1061-1065.

［10］Adams JDJ, Walker JB, Loeffler M. Avoid the In-Out-In posterosuperior femoral neck screw: the use of the piriformis fossa radiographic landmark［J］. J Orthop Trauma, 2022,36(5):224-227.

［11］Shang HX, Liu AQ, Ding Q, et al. Treatment of femoral neck fracture with hollow screws internal fixation under the monitoring of G-arm X-ray［J］. Chinese Journal of Orthopaedic Trauma, 2013,15(2):180-182. (in Chinese)

尚宏喜,刘安庆,丁强,等. G型臂X线机监视下微创空心螺纹钉内固定治疗股骨颈骨折［J］.中华创伤骨科杂志, 2013, 15(2): 180-182.

［12］ Duan MM, Cao Q, Liu J, et al. Application value of G-arm X-ray machine in placement of cannulated screws for femoral neck fracture［J］. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2019, 25(4):523-526. (in Chinese)

段明明,曹强,刘军,等. Ｇ型臂Ｘ线机在股骨颈骨折空心钉置入中的应用价值［J］.中国中西医结合外科杂志, 2019, 25(4): 523-526.

［13］Wei Zh, Xiong WF, Zhang ShM. The remnant circumferential cortex in pertrochanteric femoral fractures: CT image study and clinical implications［J］. Chinese Journal of Clinical Anatomy, 2020,38(6):639-645. (in Chinese)

卫禛,熊文峰,张世民.转子间骨折中股骨干近侧断面环周皮质的CT影像学测量及其临床意义［J］.中国临床解剖学杂志，2020，38(6）：639-645.

［14］Huang B, Rong ShY, Li JH, et al. Biplanar robot navigation for cannulated screw fixation in the treatment of femoral neck fractures［J］. Chinese Journal of Orthopaedics, 2017,37(9):528-534. (in Chinese)

黄波,荣绍远,李建华,等. 双平面机器人导航辅助下空心钉内固定治疗股骨颈骨折［J］. 中华骨科杂志, 2017,37(9):528-534.

［15］He M, Han W, Zhao CP, et al. Evaluation of a Bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures［J］. Orthop Surg, 2019, 11(3):373-379.

［16］Moulin B, Tselikas L, De Baere T, et al. CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS)［J］. Eur Radiol,2020,30(2):943-949.

［17］Chen M, Fan XH, Zheng J, et al. C-arm hip fluoroscopy at primary position in the internal fixation of femoral neck fracture［J］. Chinese Journal of Orthopaedic Trauma, 2020,22(5): 445-449. (in Chinese)

陈敏,樊晓海,郑杰,等. 原位髋部透视法在股骨颈内固定术中的临床应用［J］. 中华创伤骨科杂志, 2020,22(5): 445-449.

［18］Zhang Q, Chen W, Zhang ZK, et al. Experimental study on the optimal projection angle of femoral neck fracture line［J］. Journal of Hebei Medical University, 2010,31(39):1115-1117. (in Chinese)

张奇, 陈伟, 张泽坤, 等. 股骨颈骨折线最佳投照角度的实验研究［J］. 河北医科大学学报，2010，31（9）：1115-1117.

［19］Li F, Ma JX, Wang XB, et al. The experimental of the optimal angle position of X-ray in the close reduction of femoral neck fracture using internal fixation［J］. Chinese Journal of Orthopaedics,2017,37(11):735-745.(in Chinese)

李飞,马剑雄,王兴博，等. 股骨颈骨折闭合复位最佳X线投照方式的实验研究［J］. 中华骨科杂志, 2017,37(11):735-745.

［20］Zhang L, Lin GM, Yang GJ, et al. Multiple radiographic projections in detecting intraarticular screw penetration during fixation of femoral neck fractures［J］. Orthopedics, 2014,37(10):e885-891.

［21］Kumar A, Jameel J, Qureshi OA, et al. Modified radiographic views to prevent the anterosuperior and posterosuperior bony violation during screw fixation of femoral neck fractures［J］. Eur J Orthopaedic Surg Traumatol, 2021,31(3):459-464.

［22］Kumar A, Kumar M, Arora R, et al. Radiographic quantification of safe zones for screw placement in the femoral neck: a computed tomography-based analysis［J］. J Orthop Trauma, 2021,35(3):136-142.