本文選題：股骨轉(zhuǎn)子間骨折　切入點：外側(cè)壁　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:旨在比較股骨轉(zhuǎn)子間骨折的AO分型、Evans-Jensen分型及Gotfried外側(cè)壁骨折分型分別在X線與CT影像檢查下診斷結(jié)果的真實性與可靠性,分析兩種影像方法在股骨轉(zhuǎn)子間外側(cè)壁骨折診斷和分型中的優(yōu)缺點及作用,并指導(dǎo)正確的手術(shù)治療。方法:本研究通過收集我院2011年11月—2017年6月的術(shù)前X線和CT影像學(xué)資料完整的66例股骨轉(zhuǎn)子間骨折患者,在上級醫(yī)師及科主任的指導(dǎo)下,通過兩種影像學(xué)資料,分別對每個病例進行AO分型、Evans-Jensen分型及Gotfried外側(cè)壁骨折分型,分型結(jié)果與臨床出院診斷分型進行比較,統(tǒng)計X線與CT影像對診斷結(jié)果的真實性與可靠性。結(jié)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外側(cè)壁骨折分型的I、II、III型,CT診斷的靈敏度高于或等于X線診斷,漏診率低于或等于X線診斷,特異度高于或等于X線診斷,誤診率低于或等于X線診斷,符合率均高于X線診斷。說明CT正確檢出病例、排除非病例的能力優(yōu)于X線。AOA2.1型,X線的kappa值=0.57,屬于中度可信。CT的kappa值=1,屬于完全可信。A2.2型X線的kappa值=0.32,屬于輕中度可信。CT的kappa值=0.92,屬于完全可信。A2.3型X線的kappa值=0.86,屬于完全可信。CT的kappa值=0.86,屬于完全可信。A3.1型X線的kappa值=0.37,屬于輕中度可信。CT的kappa值=0.92,屬于完全可信。Evans-Jensen分型II型X線的kappa值=0.51,屬于中度可信。CT的kappa值=1,屬于完全可信。III型X線的kappa值=0.27,屬于輕中度可信。CT的kappa值=0.94,屬于完全可信。IV型X線的kappa值=0.62,屬于基本可信。CT的kappa值=0.96,屬于完全可信。V型X線的kappa值=0.51,屬于中度可信。CT的kappa值=0.93,屬于完全可信。Gotfried外側(cè)壁骨折分型I型X線的kappa值=0.69,屬于基本可信。CT的kappa值=0.97,屬于完全可信。II型X線的kappa值=0.77,屬于基本可信。CT的kappa值=0.85,屬于完全可信。III型X線的kappa值=0.61,屬于基本可信。CT的kappa值=0.84,屬于完全可信。結(jié)論:1.CT正確檢出病例、排除非病例的能力優(yōu)于X線。2.CT診斷結(jié)果的一致性要高于X線的診斷結(jié)果,尤其是AO分型的A2.1、A2.2、A3.1型,Evans-Jensen分型的II、III、V型,可以獲得較高的可信度。但是,CT并不能明顯提高AO分型、Evans-Jensen分型的其他壓型及Gotfried外側(cè)壁骨折分型的可信度。可見,CT三維重建圖像能使我們更加清楚地了解骨折的類型,準(zhǔn)確判斷骨塊的位置,具有一定的臨床應(yīng)用價值。3.CT提高了股骨轉(zhuǎn)子間骨折的AO分型、Evans-Jensen分型及Gotfried外側(cè)壁骨折分型的真實性與可靠性,可有效的指導(dǎo)治療方法的選擇。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R683;R816.8

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