320排CT三维重建对不同分型股骨粗隆间骨折的临床指导价值观察  

Clinical Guidance Value of 320-slice CT Three-dimensional Reconstruction for Intertrochanteric Fractures of Different Classifications

作　　者：武志刚[1] 滕涛[1] 刘高甬 路聪哲 WU Zhi-gang;TENG Tao;LIU Gao-yong(Department of Orthopedics,Beijing Pulen Hospital,Beijing 100062,China)

机构地区：[1]北京市普仁医院骨科,北京100062 [2]解放军总医院第六医学中心干部保健科,北京100048

出　　处：《中国CT和MRI杂志》2020年第11期156-158,173,共4页Chinese Journal of CT and MRI

摘　　要：目的分析320排CT三维重建对不同分型股骨粗隆间骨折的临床指导价值。方法选取北京市普仁医院收治的62例股骨粗隆间骨折患者,术前均接受320排CT三维重建与X线检查,比较320排CT三维重建、X线及术中测量结果;依据股骨粗隆间骨折AO分型与Evans分型,分析320排CT三维重建分型的诊断效能。结果X线检查骨折块数量明显少于术中测量与320排CT三维重建(P<0.05),术中测量与320排CT三维重建测得骨折块数量比较无显著差异(P>0.05);320排CT三维重建所测骨折端不稳定、骨折骨皮质不连续比例明显高于X线(P<0.05);320排CT三维重建分型包括不稳定型(U型)与稳定型(S型),S型分为2个亚型,S1型:顺粗隆间线骨折,进行三维重建,发现前方以及后方粗隆嵴完整,没有任何骨折块;S2型:顺粗隆间线骨折,伴随小粗隆骨折,其中小粗隆内上方呈现完整股骨矩;U型可以分为4个亚型,U1型:沿着粗隆间骨折,发现后方粗隆嵴存在巨大骨折块;U2型:沿着粗隆间骨折,伴随大小粗隆分离或者粉碎性骨折;U3型:沿着粗隆间骨折,伴随逆粗隆间骨折A3-3;U4型:为EvansⅡ型骨折以及AO分型A3-1。结论相较于X线,320排CT三维重建技术可更准确呈现股骨粗隆间骨折详细解剖学变化,其分型对患者治疗发挥重要指导作用。Objective To analyze the clinical guiding value of 320-slice CT threedimensional reconstruction for the different classifications of intertrochanteric fractures.Methods A total of 62 patients with intertrochanteric fractures who were admitted to Beijing Puren Hospital were enrolled.All patients underwent 320-slice CT threedimensional reconstruction and X-ray examination before surgery.The results of 320-slice CT three-dimensional reconstruction,X-ray and intraoperative measurement were compared.According to AO classification and Evans classification of intertrochanteric fractures,the classifications of 320-slice CT three-dimensional reconstruction were analyzed.Results The number of fractures detected by X-ray was significantly less than that by intraoperative measurement and 320-slice CT three-dimensional reconstruction(P<0.05).There was no significant difference in the above number between intraoperative measurement and 320-slice CT three-dimensional reconstruction(P>0.05).The proportion of fracture end instability and fracture cortical discontinuity detected by 320-slice CT three-dimensional reconstruction was significantly higher than that by X-ray(P<0.05).The classifications of 320-slice CT three-dimensional reconstruction included unstable type(U type)and stable type(S type).S type was divided into 2 subtypes,S1 type:along intertrochanteric line fracture,three-dimensional reconstruction was performed.The front and rear tuberosity crest was intact,without any fracture block.S2 type:along intertrochanteric line fracture,accompanied with small intertrochanteric fracture.There was complete calcar femorale in upper small tuberosity.U type could be divided into 4 subtypes,U1 type:along intertrochanteric fracture,there were large fracture blocks at rear tuberosity crest.U2 type:along intertrochanteric fracture,accompanied with large or small tuberosity separation or comminuted fracture.U3 type:along intertrochanteric fracture,accompanied with inverted intertrochanteric fracture A3-3.U4 type:Evans type II fracture

关 键 词：X线计算机 三维重建 分型 股骨粗隆间骨折 

分 类 号：R683.3[医药卫生—骨科学]