股骨颈骨折严重程度的CT评估

Assessment of the severity of femoral neck fractures with CT scan

目的建立股骨颈骨折的CT评估方法和量化指标。方法搜集2008年12月至2013年4月收治的229例股骨颈骨折患者术前X线影像学资料及CT原始数据，从CT三维重建片上观察骨折处有无后侧游离骨折片和骨折线位置，并测量向后成角、纵向最大位移及颈干角差值。根据以上指标将股骨颈骨折的严重程度分为轻度（≤5分，I型）、中度（6～8分，Ⅱ型）、重度（≥9分，Ⅲ型）3个等级，股骨颈爆裂性骨折定义为重度。结果存在游离骨折片的患者35例（15．3％），无明显游离骨折片的194例（84．7％）。无成角患者27例（11．8％），成角≤30°者44例（19．2％），30°～60°者115例（50．2％），≥60°43例（18．8％）。无移位患者20例（8．7％），最大位移≤10mm者96例（41．9％），10～20mm者96例（41．9％），≥20mm者17例（7．4％）。骨折线位置：头下型骨折131例（57．2％），头颈型88例（38．4％），经颈型9例（3．9％）。颈干角差值为0的患者12例（5．2％），≤10°者105例（43．4％），10°～20°者84例（35．3％），≥20°者28例（17．6％）。对299例患者的骨折严重程度在不同Garden分型中的分布：Garden I型均为轻度，GardenⅡ型含轻度15例（45．5％），中度18例（54．5％）；GardenⅢ型含轻度6例（3．1％），中度123例（64．7％），重度61例（32．2％）；Garden Ⅳ型均为重度骨折患者。结论CT对于股骨颈骨折的评估更为精确、客观，可靠性强并可使之量化。

Objective To develop a quantitative assessment of the severity of femoral neck fractures with CT scan. Methods The preoperative X-ray and CT data were reviewed of 229 patients with femoral neck fracture who had been treated in our department from December 2008 to April 2012. Posterior fracture fragment, posterior angulation, longitudinal maximum displacement, location of fracture line, and difference in neck-shaft angle were measured in the 3-D reconstruction images of CT scans. The severity of the fracture was categorized as slight, （score ≤5, grade Ⅰ）, moderate （score 6 to 8, grade Ⅱ） and severe （score ≥9, grade Ⅲ） according to the measurements of the above 5 indexes. A comminuted fracture was categorized into grade Ⅲ. Results Posterior comminutions were found in 35 cases （15.3%）, but not in the other 194 ones （84.7 % ）. No posterior angulation was observed in 27 cases （11.8%）. Posterior angulation ≤30° was found in 44 cases （19.2%）, that from 30° to 60° in 115 cases （50. 2% ）, and that ≥60° in 43 cases （18.8%）. Twenty patients（8.7% ） had no displacement. Fracture displacement ≤ 10 mm was observed in 96 cases （41.9%）, that from 10 to 20 mmin96 cases （41.9%）, and that ≥20mmin 17 cases （7.4%） . The facture line was located below the head in 131 cases （57.2%）, at the head-neck in 88 cases （38.4%）, and across the neck in 9 cases （3.9%）. The difference in neck-shaft angle was 0° in 12 cases （5.2%）, ≤ 10° in 105 cases （43.4%）, 10° to 20° in 84 cases （35.3%） and ≥20° in 28 cases （17.6%）. In the 229 cases, our severity scores were related to Garden classification in the following manners： all Garden Ⅰ cases belonged to grade Ⅰ; Garden Ⅱ cases contained grade Ⅰ in 15 cases （45.5%） and grade Ⅱ in 18 cases （54. 5% ）; Garden Ⅲ cases included grade Ⅰ in 6 cases （3.1%）, grade Ⅱ in 123 cases （64.7%） and Grade Ⅲ in 61 cases （32.2%）; all Garden Ⅳ cases were Grade Ⅲ. Conclusion In assessment of the severity of femoral neck fractures, CT scans can be more accurate, objective and reliable, and can be quantified as well.