多层螺旋CT三维重建与X线片在股骨粗隆间骨折患者手术治疗中的应用比较

摘要

Objective To analyze the application value of multi-slice spiral CT three-dimensional (3D) reconstruction and X-ray plain film in the surgical treatment of femoral intertrochanteric fractures and the importance of anatomical reduction during surgery.Methods Eighty patients with femoral intertrochanteric fractures were randomized into 3D reconstruction group (n =40) and plain film group (n =40).Femoral proximal CT 3D reconstruction was performed in 3D reconstruction group before and after surgery.According to the images of 3D reconstruction,the skeletal 3D geometrical anatomic form model was established for anatomical reduction during surgery;X-ray plain films of plain film group were taken before surgery,and femoral proximal CT 3D reconstruction was performed after surgery;The effects of surgical reduction were evaluated by CT 3D reconstruction,including femoral cross-sectional area (CSA),ratio of CSA and normal cross section area of the same part,femoral neck anteversion angle (FNAA),neck shaft angle (NSA),time in bed after surgery,fixation stability and incidence rates of loosening or rupture of internal fixator,fracture displacement,bone nonunion and other complications.Results After surgery,CSA of 3D reconstruction group was significantly larger than that of plain film group,the ratio of CSA and the normal cross-sectional area of the same part,FNAA and FNAA were significantly smaller,the difference was significant(P＜0.05),the time in bed after surgery was significantly shorter than plain film group,the difference was significant (P＜0.01),short-term fixation stability (100％) was significantly better than that of plain film group (90％),and the incidence rates of loosening or rupture of internal fixator and fracture displacement were significantly lower than those in plain film group,the difference was significant(P＜ 0.05).Conclusion Compared with X-ray plain film,femoral proximal CT 3D reconstruction before surgery is helpful to anatomical reduction during surgery of femoral intertrochanteric fractures,improvement of reduction effect,promotion of recovery and reduction of the risks of long-term loosening or rupture of internal fixator and fracture displacement.%目的 分析多层螺旋CT三维重建与X线片在股骨粗隆间骨折患者手术治疗中的应用价值和术中解剖复位对手术治疗效果的重要性.方法 将80例股骨粗隆间骨折患者按随机数表法分为三维重建组40例和X线片组40例.三维重建组于术前、术后行股骨近端CT三维重建,依据三维重建图像建立骨骼三维几何解剖形态模型,术中力求解剖复位;X线片组术前仅拍摄X线片,术后行股骨近端CT三维重建;2组术后均行CT三维重建评估手术复位效果,包括股骨横截面面积(CSA)、CSA与同一部位正常截面积之比、股骨颈前倾角(FNAA)、颈干角(NSA)、术后卧床时间、固定稳定性及内固定物松动或断裂、骨折再移位、骨不连等并发症发生率.结果 三维重建组术后CSA大于X线片组,CSA与同一部位正常截面积之比、FNAA、NSA较X线片组小,差异有统计学意义(P＜0.05).三维重建组术后卧床时间较X线片组短,差异有统计学意义(P＜0.01),短期固定稳定性100％优于X线片组90％,且内固定物松动或断裂、骨折再移位发生率明显低于X线片组,差异有统计学意义(P＜0.05).结论 与X线片相比,术前骨近端CT三维重建有助于股骨粗隆间骨折术中解剖复位,有利于显著改善复位效果,促进患者尽快下床与恢复,降低远期内固定物松动或断裂、骨折再移位发生风险.