64排螺旋CT对粗隆间骨折Evans分型的影响研究

目的:探讨64排螺旋CT对粗隆间骨折Evans分型的影响,为临床使用提供参考依据。方法:2015年3月至2017年3月,三甲医院高年资创伤骨科主任医师2名,医师1、医师2分别按照术前X线、术前64排螺旋CT平扫和三位重建结果对128例新鲜闭合单侧粗隆间骨折患者进行Evans分型,分别记为X线分型、CT分型。本院术者依据围术期X线、CT及术中所见骨折情况进行Evans分型(逆粗隆间骨折定义为Ⅴ型)作为最终分型。记录分型结果,计算并对比准确率、误诊率。结果:(1)剔除5例,90.09%(123/128)的患者完成研究。(2)分型结果:X线分型中,3例(最终分型Ⅲ型2例,Ⅳ型1例)无法定型;Ⅰ型正确1例,改为Ⅱ型1例;Ⅱ型正确18例,改为Ⅰ型2例,改为Ⅲ型3例,Ⅳ型2例;Ⅲ型正确45例,改为Ⅱ型7例,改为Ⅳ型1例;Ⅳ型正确19例,改为Ⅱ型3例,改为Ⅲ型15例。CT分型中,Ⅰ型正确3例,Ⅱ型正确29例,Ⅲ型正确64例,改为Ⅳ型1例,Ⅳ型正确22例,Ⅴ型正确3例。(3)CT分型的总准确率、总误诊率优于X线分型(99.19%vs67.48%、0.81%vs30.08%,P0.05)。(4)Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型骨折进行CT分型,准确率高于X线分型(P0.05),误诊率低于X线分型(P0.05);Ⅴ型骨折,两种分型准确率、误诊率相等。结论:64排螺旋CT平扫及三维重建是粗隆间骨折Evans分型较为可靠的辅助检查,可考虑推广运用。

Effect of 64 Slice Spiral CT on Evans Classification of Intertrochanteric Fractures

ABSTRACT Objective: To investigate the effect of 64-slice spiral CT on Evans classification of intertrochanteric fractures, and to provide reference for clinical use. Methods: From March 2015 to March 2017, 128 patients with unilateral unilateral intertrochanteric fractures were classified by Evans according to preoperative X-ray, preoperative 64-slice spiral CT plain scan and three-dimensional reconstruction, and were classified into X-ray and CT types. According to the perioperative X-ray, CT and intraoperative findings of the fracture, Evans classification (inverse intertrochanteric fracture defined as type V) as the final classification. The typing results were recorded, and the accuracy and misdiagnosis rate were calculated and compared. Results: 5 patients were excluded and 90.09% (123/128) completed the study. Typing results: 3 cases (2 cases of final type III, 1 case of type IV) could not be typed; 1 case of correct type I was changed to type II 1 case; 18 cases of correct type II were changed to type I 2 cases, changed to type III 3 cases, changed to type IV 2 cases; 45 cases of correct type III, changed to type II 7 cases, changed to type IV 1 case; 19 cases of correct type IV, changed to type II 3 cases. 15 cases were changed to type III. Among the CT typing, 3 were correct in type I, 29 in type II, 64 in type III, 1 in type IV, 22 in type IV, and 3 in type V. The total accuracy and misdiagnosis rate of CT typing were better than that of X-ray typing (99.19% vs 67.48%, 0.81% vs 30.08%, P<0.05). For type I, type II, type III and type IV fractures, the accuracy of CT classification was higher than that of X-ray classification (P<0.05), and the misdiagnosis rate was lower than that of X-ray classification (P<0.05); for type V fractures, the accuracy and misdiagnosis rate of the two types were equal. Conclusion: 64-slice spiral CT plain scan and three-dimensional reconstruction are reliable auxiliary examinations for Evans classification of intertrochanteric fractures, and can be considered for popularization and application.