CT三维重建技术对踝关节骨折Lange-Hansen分型及评估术后疗效的价值分析  

Study on the value of CT three-dimensional reconstruction technique for ankle fracture Lange-Hansen classification and evaluation of postoperative efficacy

作　　者：代俊楠 张亚楠 陈雨晴 王国良 DAI Junnan;ZHANG Yanan;CHEN Yuqing;WANG Guoliang(Department of Radiology,The Third Medical Center,PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第三医学中心放射诊断科,北京100039

出　　处：《医学影像学杂志》2025年第3期104-107,共4页Journal of Medical Imaging

基　　金：北京市自然科学基金项目(编号:7222319)。

摘　　要：目的 探讨CT三维重建技术对踝关节骨折Lange-Hansen分型及评估术后疗效的价值。方法 选取103例踝关节骨折患者,术前、术后均行X线摄影检查和CT结合三维重建技术进行Lauge-Hansen分型及疗效评价,以术中探查结果及术后3个月踝-后足功能评分AOFAS量表疗效作为金标准,比较X线摄影检查、CT三维重建技术对LaugeHansen分型及疗效评估的一致性和准确率。结果 X线摄影检查对踝关节骨折Lauge-Hansen分型的Kappa=0.724,一致性较好;CT三维重建和X线摄影检查对踝关节骨折Lauge-Hansen分型的Kappa=0.961,一致性很好。103例患者术中探查共有SAB、SER、PER、PAB四型,分别为29例、31例、24例、19例;CT三维重建SAB、SER、PER、PAB四型和总分型的符合率分别为93.10%、100%、100%、94.74%、97.09%,均高于X线摄影检查的72.41%、87.10%、87.50%、68.42%、79.61%,差异有统计学意义(P<0.05)。103例患者术后3个月AOFAS量表评价结果显示,踝关节恢复优良88例,优良率85.44%,可和差15例。X线摄影检查复位效果、内固定效果与术后3个月AOFAS量表评价结果的Kappa=0.502,0.353,复位效果评价的一致性一般,内固定效果评价的一致性差;CT三维重建复位效果、内固定效果与术后3个月AOFAS量表评价结果的Kappa=0.880,0.825,复位效果评价的一致性很好,内固定效果评价的一致性较好(P均<0.001)。结论 CT三维重建技术可在术前准确判断踝关节骨折Lauge-Hansen分型,而且术后对复位效果与内固定效果的评价结果与患者功能恢复具有高度的一致性。Objective To evaluate the value of three-dimensional CT reconstruction in the classification of Angel-Hansen ankle fracture and the evaluation of postoperative efficacy.Methods A total of 103 patients with ankle fractures were selected and Lauge-Hansen classification and efficacy evaluation were performed by X-ray examination and CT combined with 3D recon-struction technology before and after surgery.Intraoperative exploration results and the efficacy of ankle-hind foot function score AOFAS scale 3 months after surgery were used as the gold standard.We compared the consistency and accuracy of X-ray and CT 3D reconstruction techniques for Lauge-Hansen classification and efficacy evaluation.Results The Kappa of Lauge-Hansen classification of ankle fracture was 0.724 with good consistency.The Kappa of Lauge-Hansen classification of ankle fractures by CT 3D reconstruction and radiographs was 0.961,with good agreement.There were four types of SAB,SER,PER and PAB in 103 patients,in whom there were 29 cases,31 cases,24 cases and 19 cases,respectively.The coincidence rates of SAB,SER,PER,PAB and total type in CT 3D reconstruction were 93.10%,100%,100%,94.74%and 97.09%,respectively.They were higher than that of X-ray films(72.41%,87.10%,87.50%,68.42%,79.61%).The difference was statistically significant(P<0.05).The results of AOFAS scale evaluation of 103 patients 3 months after operation showed that 88 cases had excellent ankle joint recovery,the excellent and good rate was 85.44%,and 15 cases had poor ankle joint recovery.The Kappa of X-ray reduc-tion effect,internal fixation effect and AOFAS scale evaluation results 3 months after surgery were 0.502,0.353.The consistency of reduction effect evaluation was general,and that of internal fixation effect evaluation was poor.The Kappa of CT 3D reconstruc-tion reduction effect,internal fixation effect and AOFAS scale evaluation results at 3 months after surgery were 0.880,0.825,in-dicating a good consistency in the evaluation of reduction effect and a good consistency in the e

关 键 词：体层摄影术 X线计算机 三维重建技术 踝关节骨折 Lange-Hansen分型 术后疗效 

分 类 号：R683.42[医药卫生—骨科学] R814.42[医药卫生—外科学]