螺旋CT联合多平面重建技术对老年股骨颈骨折患者临床诊断价值研究

Clinical application value of spiral CT three-dimensional reconstruction and multiplanar reconstruction in elderly patients with femoral neck fracture

目的研究螺旋CT三维重建(CT3D)及多平面重建(multiplanar reformation,MPR)对老年股骨颈骨折患者的临床诊断价值。方法选取宜君县人民医院外科及陕西省人民医院骨科2017年3月至2019年5月收治且最终经手术确诊的91例老年股骨颈骨折患者作为研究对象进行回顾性研究。根据术前影像学检查方法不同分为X线组(33例)和螺旋CT组(58例)。比较两组间股骨颈骨折Garden分型的诊断符合率;内固定手术治疗后对两组患者进行14个月随访,比较两组骨折延迟愈合或不愈合,以及股骨头坏死等情况。结果X线摄片结果提示33例病例中,Garden分型:Ⅰ型1例、Ⅱ型6例、Ⅲ型12例、Ⅳ型14例,共5例与术中诊断不一致,诊断符合率为84.85%。螺旋CT三维重建及多平面重建结果提示58例病例中,Garden分型:Ⅰ型5例,Ⅱ型20例,Ⅲ型33例,共1例与术中诊断不一致,诊断符合率为98.28%,螺旋CT诊断符合率显著高于X线摄片(P<0.05);X线组术后14个月骨折延迟愈合或不愈合,以及股骨头坏死发生率显著高于螺旋CT组,差异具有统计学意义(P<0.05)。结论在老年股骨颈骨折患者的诊断、分型及预后评估中,与X线摄片相比,螺旋CT三维重建及MPR可取得明显更佳的诊断效果。

Objective To study the clinical application value of spiral CT three-dimensional reconstruction(CT3 D) and multiplanar reconstruction(MPR) in elderly patients with femoral neck fracture.Methods 91 patients with femoral neck fractures admitted to our hospital from March 2017 to May 2019 and confirmed by surgery or pathological diagnosis were selected as the research subjects.The patients were divided into Xray group(33 patients) and spiral CT group(58 patients).The diagnosis coincidence rate of Garden classification of femoral neck fracture between the two groups was compared;after 14 months of follow-up,delayed union or nonunion of fracture and osteonecrosis of femoral head(ONFH) were compared between the two groups.Results The results of X-ray film showed that there were 1 case of garden type Ⅰ,6 cases of type Ⅱ,12 cases of type Ⅲ and 14 cases of type Ⅳ.5 cases were inconsistent with the intraoperative diagnosis,and the diagnostic coincidence rate was 84.85%.The results of three-dimensional reconstruction and multiplanar reconstruction of spiral CT showed that there were 5 cases of garden type Ⅰ,20 cases of type Ⅱ,and 33 cases of type Ⅲ.The diagnostic coincidence rate of spiral CT was 98.28%,which was significantly higher than that of X-ray film(P<0.05).The incidence of delayed union or nonunion and necrosis of femoral head in X-ray group was significantly higher than that in spiral CT group at14 months after operation(P<0.05).Conclusion In the diagnosis,classification and prognosis evaluation of elderly patients with femoral neck fracture,compared with X-ray film,spiral CT three-dimensional reconstruction and multiplanar reconstruction can achieve significantly better diagnostic effect,which can guide the formulation of clinical operation plan.