【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。更多还原

【Abstract】 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 and AO classification A3-1. Conclusion Compared with X-ray, 320-slice CT three-dimensional reconstruction technology can more accurately present detailed anatomical changes in intertrochanteric fractures, and its classifications play important guiding roles for patient treatment.更多还原