螺旋CT在股骨颈骨折诊断与治疗中的作用

Spiral CT in diagnosis and treatment of femoral neck fractures

目的探讨螺旋CT在股骨颈骨折诊断与治疗中的作用。方法2008年12月至2010年2月共收治192例股骨颈骨折患者，男90例，女102例；年龄18—89岁，平均71．2岁。所有患者术前均行X线检查、螺旋CT扫描，对比分析两种检查方法的结果。结果X线片骨折检出率为95．8％（184／192），螺旋CT检出率为100％（192／192），差异有统计学意义（X^2=6．255，P=0．012）。4例骨折在X线片上表现为不全骨折，但在CT图像上均可发现完整的骨折线。75例在CT三维重建图像上显示股骨头有旋转移位，并能显示旋转的方向；X线片仅10例显示股骨头旋转，且不能显示旋转方向。螺旋CT检查显示47．9％（92／192）的患者骨折端有明显的碎骨片，X线检查显示12．5％（24／192）的患者骨折端有碎骨片，二者对碎骨片的检出率差异有统计学意义（X^2=57．116，P=0．000）。X线片分型的正确率为73．4％（58／79），螺旋CT分型的正确率为100％（79／79），差异有统计学意义（X^2=24．219，P=0．000）。根据螺旋CT检查结果，对3l例（16．1％）患者的治疗方案进行了更改。结论螺旋CT扫描及三维重建可以真实、立体、多角度地显示股骨颈骨折，在骨折检出、判断分型、显示股骨头旋转和骨折碎骨片方面均优于X线检查，对股骨颈骨折的诊治具有重要的临床意义。

Objective To investigate the value of spiral CT in diagnosis and treatment of femoralneck fractures. Methods From December 2008 to February 2010, 192 cases of femoral neck fractures were examined first by X-ray and next by spiral CT scanning plus three-dimensional reconstruction. They were 90 men and 102 women, aged from 18 to 89 years （average, 71.2 years） . The differences of the 2 examinations were compared. Results The diagnostic rate of X-ray was 95.8% （184/192）, significantly lower than that of spiral CT [ 100% （ 192 / 192） ] （X^2 = 6. 255, P = 0. 012）. Four fractures were shown as incomplete on X-ray films, hut demonstrated as complete on CT images. Spiral CT three-dimensional reconstruction demonstrated rotated displacement and rotation direction of the femoral head in 75 cases while X-ray only showed rotated displacement in 10 cases without demonstration of the rotation direction. Bone chips in 47.9% （92/192） of the patients were demonstrated by spiral CT, significantly higher than those by X-ray [ 12.5% （24/192）] （X^2 = 57. 116, P = 0. 000）. Correct fracture typing by X-ray was 73.4% （58/79）, significantly lower than that by spiral CT 100% （79/79） （X^2 = 24. 219, P =0. 000）. According to Spiral CT results, treatment protocols were adjusted for 31 patients. Conclusion In diagnosis and treatment of femoral neck fractures, spiral CT is more valuable than X-ray because it can demonstrate three-dimensional details of a specific fracture.