CT三维重建与X射线片应用于转子间骨折分型的可靠性

背景：三维CT重建开始较广泛地应用于转子间骨折的分型。目的：比较不同转子间骨折分型方法在三维CT重建与X射线片中的准确性与精确性。方法：对68例转子间骨折病例行术前CT及X射线片检查，CT资料以dicom格式导入mimics10.0软件进行三维重建。影像资料分别由3位骨科医师进行读片，并采用AO、Evans分型方法对其进行分型。计算3位医师采用CT三维重建方法与X射线片方法时AO分型与Evans分型组结果之间的x值；计算每位医生先后采用X射线片与CT三维重建时在AO分型组与Evans分型组中的x值；基于x值评价各组间的一致性。结果与结论：剔除18例图像不清晰者，50例获得了满意的图像。基于X射线片的分型与基于CT三维重建的分型，无论采取何种分型方法，三维CT重建组中的x值均大于X射线片的x值；无论采取三维CT还是X射线片，AO分型组的x值均大于AO亚型组与Evans分型组。因而，得出采用三维CT重建对转子间骨折进行分型，不但可以提高分型的准确性，而且可以提高分型的精确性；AO分型的准确性与精确性大于Evans分型。 

Reliability of three-dimensional CT reconstruction and X-ray image for intertrochanteric fracture classification

BACKGROUND: Three-dimensional CT reconstruction has been widely used in the classification of intertrochangeric fractures. OBJECTIVE: To compare the reliability of currently used classification systems with three-dimensional CT and X-ray image for intertrochanteric fractures of the proximal femur.  METHODS: Sixty-eight cases with intertrochanteric fractures of the proximal femur were subjected to CT and X-ray examination, and then the CT data were imported into the mimics10.0 software with dicom format to do the three-dimensional reconstruction. The three-dimensional data were classified independently by three experienced observers using the AO and Evans classification systems. The kappa value of AO and Evans classification groups of three observers was calculated when using the X-ray and three-dimensional CT image, as well as the kappa value of AO and Evans classification group between the observers when using the X-ray and three-dimensional CT image. Then the consistency among the three groups based on the kappa values was evaluated. RESULTS AND CONCLUSION: Excluding 18 cases with unclear image, 50 cases obtained the satisfactory image. As for the typing based on the X-ray image and three-dimensional CT image, the kappa value in the three-dimensional CT image group was larger than that in the X-ray image group no matter which method we used; the the kappa value in the AO typing group was larger than that in the AO subgroup and Evans typing group no matter which method we used. Results indicate that the three-dimensional CT can be used more reliably to measure intertrochanteric fractures of the proximal femur than X-ray, and the reliability of the AO classification was more satisfactory than Evans.