64层螺旋CT联合三维重建在股骨颈骨折治疗方案选择和预后评估中的价值

Value of 64-slice spiral CT combined with three-dimensional reconstruction in the treatment selection and prognosis evaluation of femoral neck fracture

目的:探讨64层螺旋CT联合三维重建在股骨颈骨折(FNF)治疗方案选择和预后评估中的价值。方法:回顾性分析2020年1—10月收治的180例FNF患者,随机数字表法分为观察组(90例)和对照组(90例),随访2年,根据预后是否良好分为预后良好组(83例)和预后不良组(7例)。Logistic分析影响预后的因素;拟合曲线、阈值效应分析CT扫描联合三维重建与预后的关系;构建风险评分模型并评价其效能。结果:观察组诊断符合率明显高于对照组(P<0.05);年龄>60岁、车祸受伤和重物砸伤、Garden分型Ⅲ型和Ⅳ型、头下型、骨折线倾斜角度分型Ⅲ型、Garden指数Ⅲ级和Ⅳ级、骨折闭合内固定术、手术前未牵引、手术时间>72 h为预后不良的危险因素(P<0.05)。Garden分型降低,预后不良可能性下降。高危组不良反应发生率明显高于低危组和中危组(P<0.001)。风险预测模型的区分度、准确度较高。结论:64层螺旋CT联合三维重建可减少手术时间,优化骨折复位效果,减少术后不良反应。

Objective:To evaluate the value of 64-slice spiral CT combined with three-dimensional reconstruction in the treatment and prognosis of femoral neck fracture(FNF).Methods:A total of 180 patients with FNF admitted to the hospital from January to October 2020 were retrospectively analyzed.Patients were randomly divided into the observation group(90 cases)and control group(90 cases).After two years of follow-up,they were divided into a good prognosis group(83 cases)and a poor prognosis group(7 cases)according to whether the prognosis was good or not.Logistic analysis of prognostic factors;fitting curve and threshold effect analysis were adopted to study the relationship between CT scanning combined with three-dimensional reconstruction results and the patient's prognosis.A risk score model was constructed and its efficacy was evaluated.Results:The age>60 years,traffic acci dent injury and heavy object injury,Garden typeⅢandⅣ,subcephalic type,fracture line tilt angle typeⅢ,Garden indexⅢgrade andⅣgrade,closed internal fixation of fracture,no traction before operation and operation time>72 hours were the risk factors of poor prognosis.Higher Garden classification levels were related to the poor prognosis.The incidence of adverse reactions in high-risk group was significantly higher than that in the low-risk group and medium-risk group(P<0.001).The differentiation rate and accuracy of the risk prediction model are high.Conclusion:The 64-slice spiral CT combined with three-dimensional reconstruction applied before operation can effectively reduce the operation time,optimize the effect of fracture reduction,and reduce postoperative adverse reactions.