摘要
目的通过股骨转子间骨折病例分型比较,根据CT三维重建(3D-CT)骨折形态提出“基座”理论及“基座”稳定性评分和分度,并探讨其临床指导意义。方法回顾性分析成都市新都区人民医院行3D-CT的211例股骨转子间骨折患者(包括151例手术患者)的临床资料,根据患者X射线片进行Evans分型、AO分型,根据3D-CT影像进行Shoda分型、六部分分型,结合股骨转子间骨折特点进行比较分析,提出“基座”理论及“基座”稳定性评分和分度,并探讨各类型股骨转子间骨折与“基座”损伤程度之间的关系。结果使用“基座”理论对211例患者进行稳定性评分,并分析151例患者手术前后3D-CT影像中股骨转子间“基座”受损与修复的情况,结果显示“基座”理论具有较好的临床指导意义,其中手术成功145例,手术失败6例。结论基于X射线片及现有CT分型,部分特殊病例不能被准确分型,指导临床易出现偏差。“基座”理论及“基座”稳定性评分和分度是在股骨转子间骨折3D-CT基础上,对既往各种分型的补充和完善,能对该类骨折进行较为准确的术前评估,可有效避免手术失败,且有助于指导术后康复。
Objective Based on the comparison of the types of intertrochanteric fractures,the“pedestal”theory and the stability score and grading of“pedestal”were proposed according to the fracture morphology of CT three-dimensional reconstruction(3D-CT),and its clinical guiding significance was discussed.Methods The clinical data of 211 patients with intertrochanteric fracture(including 151 patients underwent surgery)who received 3D-CT in Xindu District People’s Hospital of Chengdu were retrospectively analyzed.Evans typing and AO typing were performed according to the X-ray images of the patients,Shoda typing and six-part typing were performed according to the 3D-CT images of the patients.Based on the comparative analysis of the characteristics of intertrochanteric fractures,the“pedestal”theory and the stability score and grading of“pedestal”were proposed,and the relationship between various types of intertrochanteric fractures and the degree of“pedestal”injury were investigated.Results The“pedestal”theory was used to score the stability of 211 patients,and the damage and repair of the intertrochanteric“pedestal”in 3D-CT images of the 151 patients before and after surgery were analyzed.The results showed that the“pedestal”theory has good clinical guiding significance,and the operation was successful in 145 cases and failed in 6 cases.Conclusion Based on X-ray images and existing CT typing methods,some special cases cannot be accurately classified,which may lead to deviation in clinical guidance.The“pedestal”theory and the stability score and grading of“pedestal”are the supplement and improvement for the previous classification methods of intertrochanteric fractures on the basis of 3D-CT,which can conduct more accurate preoperative evaluation,effectively avoid surgical failure,and help to guide postoperative rehabilitation.
作者
王科学
秦毅
赖国维
石钊
聂政
霍玉雄
WANG Ke-xue;QIN Yi;LAI Guo-wei;SHI Zhao;NIE Zheng;HUO Yu-xiong(Department of Orthopedics,Xindu District People’s Hospital of Chengdu,Chengdu Sichuan 610500,China;Department of Human Anatomy,Chengdu Medical College,Chengdu Sichuan 610500,China;Department of Orthopedics and Traumatology,Qionglai Hospital of Traditional Chinese Medicine,Qionglai Sichuan 611500,China)
出处
《局解手术学杂志》
2022年第12期1062-1067,共6页
Journal of Regional Anatomy and Operative Surgery
基金
四川省医学会骨科(尚安通)专项科研课题(2019SAT35)。
关键词
股骨转子间骨折
3D-CT
基座理论
骨折分型
intertrochanteric fractures
3D-CT
“pedestal”theory
fracture classification
