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Zhang RY, Su XY, Zhao JX, Li JT, Zhang LC, Tang PF. Three-dimensional morphological analysis of the femoral neck torsion angle-an anatomical study. J Orthop Surg Res 2020; 15:192. [PMID: 32460899 PMCID: PMC7251911 DOI: 10.1186/s13018-020-01712-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/13/2020] [Indexed: 01/31/2023] Open
Abstract
Background The femoral neck torsion angle (FNTA) is an important but often neglected parameter in assessments of the anatomical morphology of the femoral neck, which is often confused with the femoral neck anteversion angle (FNAA) in the current literature. Currently, the measurement methods reported in the literature all adopt the naked eye or two-dimensional (2D) visualization method, and the measurement parameters and details are not clearly defined. The objection of this research was to provide a reliable 3D method for determining the femoral neck axis, to improve the measurement method of the FNTA, and to analyze the anatomical and clinical significance of the results. Methods Computed tomography (CT) data of 200 patients who received a lower extremity CT angiography examination were selected, and the bilateral femurs were reconstructed with three dimensional CT (3D CT). First, the 3D axis of the femoral neck was built. Second, the long axis of the cross section the femoral neck isthmus (FNI) and femoral neck basilar part (FNB) were confirmed by the “inertia axes” method, and the plane consisting of the long axis of the cross-section and the center of the femoral head was defined as the long axial plane. Third, the coronal plane of the proximal femur was determined through the long axis of the proximal femur and the femoral coronal. Finally, the FNTAs (the angles between the long axial planes and the coronal plane of the proximal femur) of FNI and FNB were measured. The size of FNTA was compared between the sexes and sides and different locations, the correlation between the parameters and age, height, and weight were evaluated. Results The difference in FNTA was statistically significant between the isthmus and the basilar part (isthmus 30.58 ± 8.90° vs. basilar part 23.79 ± 3.98°; p < 0.01). Significant difference in the FNTA was observed between the sexes (males 31.99 ± 9.25° vs. females 27.49 ± 7.19°; p < 0.01). The increase in FNTA from the basilar part to the isthmus was 6.79 ± 8.06°, and the male (7.87 ± 8.57°) was greater than the female (4.44 ± 6.23°, p < 0.01). However, no significant difference in the values was observed between sides. Height exerted the greatest effect on the FNTA according to the correlation analysis (r = 0.255, p< 0.001). Conclusions This study found a reliable 3D method for the determination of the femoral neck axis improved the measurement method of the FTNTA and made it more accurate and repeatable. The results provided a methodological basis and theoretical support for the research and development of internal fixation device for femoral neck fracture and the spatial configuration of implants in treatment. And the optimal opening point of the femoral medullary cavity was recommended to locate at the posterior position of the top of the femoral neck cross-section during hip replacement.
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Affiliation(s)
- Ru-Yi Zhang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.,Department of Orthopedics, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, No. 24, Shijingshan Road, Beijing, 100043, China
| | - Xiu-Yun Su
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China
| | - Jing-Xin Zhao
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China
| | - Jian-Tao Li
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China
| | - Li-Cheng Zhang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.,Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Pei-Fu Tang
- Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China. .,Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
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