CT与X线检查在股骨转子间骨折的诊断及治疗价值比较

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摘要目的探讨CT对比X线对于股骨转子间骨折分型及手术方式的作用价值。方法多中心回顾性分析北京大学第三医院及北医三院延庆医院2016年9月以前就诊的股骨转子间骨折患者，同时留存有X线及CT检查的病例共261例，6名骨科医生分别给出X线和CT对应的AO分型及手术方式选择，收集数据并分析。结果 CT检查并没有体现出明确的分型价值；对于高年资医师，在AO分型亚型方面，在阅读CT后倾向于将部分A2.1更改为其他亚型，差异有统计学意义(P＜0.05)；在治疗方式上，高年资医师阅读CT后有32例患者因判断出外侧壁粉碎骨折而改为应用髓外板固定，差异有统计学意义(P＜0.05)，同时CT减少了不同医师在治疗方式选择上的差异。结论 CT对比X线在诊治股骨转子间骨折上存在价值，主要体现在高年资医师对于外侧壁粉碎需要行外侧壁重建的股骨转子间骨折判断更加准确，从而选择更为合适的髓外锁定板固定方式。

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	石雷 1
	吕扬 2
	周方 2*

关键词 ：股骨转子间骨折, CT, AO分型, 手术方式

Abstract：Objective To explore the value of CT and X-ray in the classification and surgical methods of intertrochanteric fractures.Methods We retrospectively analysed the patients with intertrochanteric fracture who was treated at 3rd Hospital of Peking University and Yanqing Hospital before September 2016.Therewas a total of 261 cases with X-ray and CT examination retained.Six orthopaedic surgeons determined the AO classification and surgical methods according to X-ray and CT，respectively.Results CT examination did not show clear value of classification.For senior surgeons，they tended to change part of A2.1 to other subtypes after reading CT，with statistical differences (P＜0.05).In terms of treatment methods，32 patients were changed to use extra-medullary plates due to the judgment of fracture of lateral trochanteric wallshown in CT.The differencewas statisticalsignificant (P＜0.05).Meanwhile，CT reduced the differences in treatment methods among different surgeons.Conclusion Compared with X-ray，CT of great value in the diagnosis and treatment of intertrochanteric fractures，which is mainly reflected in the fact that senior surgeons are more accurate in the judgment of lateral wall fractures which requiring reconstruction，and select extra-medullary locking plate，which is more appropriate.

Key words： intertrochanteric fractures computed tomography AO classification surgical methods

通讯作者: 周方

作者简介: 石雷(1990－ )，男，医师，北京市延庆区医院(北京大学第三医院延庆医院)，102100。

引用本文:

石雷 1，吕扬 2，周方 2*. CT与X线检查在股骨转子间骨折的诊断及治疗价值比较[J]. 实用骨科杂志, 2019, 25(4): 321-325.
Shi Lei 1，Lv Yang 2，Zhou Fang 2*. Comparison between CT and X-ray in the Diagnosis and Treatment of Intertrochanteric Fractures. sygkzz, 2019, 25(4): 321-325.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I4/321

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