X线与CT对股骨转子间外侧壁骨折分型的评价研究

发布时间：2018-03-13 09:35

本文选题：股骨转子间骨折　切入点：外侧壁　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:旨在比较股骨转子间骨折的AO分型、Evans-Jensen分型及Gotfried外侧壁骨折分型分别在X线与CT影像检查下诊断结果的真实性与可靠性,分析两种影像方法在股骨转子间外侧壁骨折诊断和分型中的优缺点及作用,并指导正确的手术治疗。方法:本研究通过收集我院2011年11月—2017年6月的术前X线和CT影像学资料完整的66例股骨转子间骨折患者,在上级医师及科主任的指导下,通过两种影像学资料,分别对每个病例进行AO分型、Evans-Jensen分型及Gotfried外侧壁骨折分型,分型结果与临床出院诊断分型进行比较,统计X线与CT影像对诊断结果的真实性与可靠性。结果:AO分型的A2.1、A2.2、A2.3及A3.1型,Evans-Jensen分型的II、III、IV、V型,Gotfried外侧壁骨折分型的I、II、III型,CT诊断的灵敏度高于或等于X线诊断,漏诊率低于或等于X线诊断,特异度高于或等于X线诊断,误诊率低于或等于X线诊断,符合率均高于X线诊断。说明CT正确检出病例、排除非病例的能力优于X线。AOA2.1型,X线的kappa值=0.57,属于中度可信。CT的kappa值=1,属于完全可信。A2.2型X线的kappa值=0.32,属于轻中度可信。CT的kappa值=0.92,属于完全可信。A2.3型X线的kappa值=0.86,属于完全可信。CT的kappa值=0.86,属于完全可信。A3.1型X线的kappa值=0.37,属于轻中度可信。CT的kappa值=0.92,属于完全可信。Evans-Jensen分型II型X线的kappa值=0.51,属于中度可信。CT的kappa值=1,属于完全可信。III型X线的kappa值=0.27,属于轻中度可信。CT的kappa值=0.94,属于完全可信。IV型X线的kappa值=0.62,属于基本可信。CT的kappa值=0.96,属于完全可信。V型X线的kappa值=0.51,属于中度可信。CT的kappa值=0.93,属于完全可信。Gotfried外侧壁骨折分型I型X线的kappa值=0.69,属于基本可信。CT的kappa值=0.97,属于完全可信。II型X线的kappa值=0.77,属于基本可信。CT的kappa值=0.85,属于完全可信。III型X线的kappa值=0.61,属于基本可信。CT的kappa值=0.84,属于完全可信。结论:1.CT正确检出病例、排除非病例的能力优于X线。2.CT诊断结果的一致性要高于X线的诊断结果,尤其是AO分型的A2.1、A2.2、A3.1型,Evans-Jensen分型的II、III、V型,可以获得较高的可信度。但是,CT并不能明显提高AO分型、Evans-Jensen分型的其他压型及Gotfried外侧壁骨折分型的可信度。可见,CT三维重建图像能使我们更加清楚地了解骨折的类型,准确判断骨块的位置,具有一定的临床应用价值。3.CT提高了股骨转子间骨折的AO分型、Evans-Jensen分型及Gotfried外侧壁骨折分型的真实性与可靠性,可有效的指导治疗方法的选择。
[Abstract]:Objective: to compare the accuracy and reliability of AO classification of intertrochanteric fracture with Evans-Jensen type and Gotfried type of lateral wall fracture under X-ray and CT images, respectively. To analyze the advantages and disadvantages of two imaging methods in the diagnosis and classification of femoral intertrochanteric wall fracture. Methods: from November 2011 to June 2017, 66 patients with intertrochanteric fracture of femur were collected from November 2011 to June 2017 under the guidance of superior physician and department director. According to the two kinds of imaging data, each case was classified by AO classification, Evans-Jensen classification and Gotfried lateral wall fracture, and the results were compared with the clinical classification. Results the sensitivity of CT in the diagnosis of A2.1 and A2.2 A2.3 and Evans-Jensen 's classification of type A 3.1 was higher than or equal to that of CT in the classification of type V Gotfried lateral wall fractures, and the sensitivity of CT was higher than or equal to that of X-ray diagnosis in the classification of the lateral wall fracture of Gotfried, the sensitivity of CT was higher than or equal to that of the CT diagnosis of type V Gotfried's lateral wall fracture. The missed diagnosis rate was lower than or equal to X ray diagnosis, the specificity was higher than or equal to X ray diagnosis, the misdiagnosis rate was lower or equal to X ray diagnosis, the coincidence rate was higher than that of X ray diagnosis. The ability to exclude non-cases is better than the kappa value of X-ray. AOA2.1, the kappa value of moderate credible. Ct is 1, the kappa value of fully credible. A2.2 X-ray is 0.32, the kappa value of mild-medium credible. Ct is 0. 92, and the kappa value of fully credible. A2.3 X-ray is 0. 92. The kappa value is 0.86, the kappa value is 0.86, the kappa value is 0.37 for fully credible .A3.1 X-ray, the kappa value is 0.92 for mild-medium credible .CT, the kappa value is 0.51 for fully credible .Evans-Jensen type II X-ray, the kappa value for moderately credible .CT is 1, and belongs to complete confidence. The kappa value of credible .III X-ray is 0.27, the kappa value of mild-medium credible .CT is 0.94, the kappa value of completely credible .IV X-ray is 0.62, the kappa value of basic credible .CT is 0.96, the kappa value of V-type X-ray is 0.51, and the kappa of medium credible .CT is 0.61. The kappa value of type I X-ray belongs to 0.69, the kappa value of basic credible .CT is 0.97, the kappa value of type II X-ray is 0.77, the value of kappa of basic credible .CT is 0.85, and that of type III X-ray is completely credible, which belongs to the type I X-ray of completely credible .Gotfried lateral wall fracture, the kappa value of type I is 0.97, the value of kappa of type II is 0.77, the value of kappa of type 0.85 belongs to basic credible. The kappa value of 0.61% and the kappa value of 0.84% of CT are completely credible. Conclusion: 1. The ability to exclude non-cases was better than that of X-ray. 2. The consistency of diagnostic results of CT was higher than that of X-ray, especially the AO classification of A2.1, A2.2, A3.1 and Evans-Jensen 's type IIIII, V-type. But CT can not obviously improve the reliability of other compression type and Gotfried lateral wall fracture classification in AO classification of Evans-Jensen. It can be seen that 3D reconstruction images of CT can make us know more clearly the type of fracture. 3. Ct can improve the authenticity and reliability of AO classification Evans-Jensen classification and Gotfried lateral wall fracture classification of femoral intertrochanteric fracture, which can effectively guide the choice of treatment methods.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683;R816.8

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