摘要目的 探讨3D打印技术辅助髋关节骨折螺旋CT三维重建(3D-CT)分型方法在诊断及治疗中的应用价值.方法 回顾性分析46例外伤性髋关节损伤的3D打印模型、X线影像影像及螺旋CT三维重建等资料的临床诊治过程.根据3D打印模型、X线影像影像、三维CT成像的影像学资料,按照如下标准进行骨折分型:Ⅰ型,髋臼一处骨折无移位;Ⅱ型,髋臼前柱和(或)前壁骨折移位<4 mm,后柱和(或)后壁骨折移位<4 mm,髋臼顶部骨折移位<2 mm;Ⅲ型,髋臼前柱和(或)前壁骨折移位>4 mm,后柱和(或)后壁骨折移位>4 mm,髋臼顶部骨折移位>2 mm;Ⅳ型,双柱骨折或T型骨折,中央型脱位;Ⅴ型,髋臼骨折合并股骨头颈骨折和(或)关节内游离体,骨盆骨折.Ⅰ、Ⅱ型患者给予牵引等保守治疗,Ⅲ、Ⅳ、Ⅴ型患者行前路或后路手术治疗.所有患者平均随访6个月,且随访资料完整.采用Harris评分法对髋关节功能进行评价.结果 X线影像与3D模型检出率比较,差异有统计学意义(P=0.012),CT与3D模型检出率比较,差异无统计学意义(P=0.083).Ⅰ型3例,Ⅱ型5例,Ⅲ型16例,Ⅳ型12例,Ⅴ型10例.根据Harris评分:优35例,良7例,可4例,优良率为91%;Ⅲ、Ⅳ、Ⅴ型患者远期优良率比较,差异无统计学意义(P=0.102、0.079、0.059).结论 传统的Jndt和Letoume1分类摄片过程复杂且角度有一定的局限性,未考虑髋臼负重区骨折、关节内游离骨块以及合并头颈、骨盆骨折等情况,三维CT分型对髋关节骨折的临床治疗具有一定的指导意义.

abstractsObjective To evaluate 3D print model and spiral 3D-CT reconstruction parting in hip fracture diagnostic and therapeutic application value. Methods A retrospective study was performed on di-agnosis by 3D print model,3D-CT and X-ray of 46 patients with hip joint fracture. According to the model of 3D printing,X-ray imaging,the 3D-CT imaging data,fracture classification according to the following stand-ards:TypeⅠ,acetabulum fracture without displacement;TypeⅡ,acetabulum anterior column and( or) front wall fracture displacement less than 4 mm,column and( or) wall fracture displacement less than 4 mm,top of the acetabulum fracture displacement less than 2 mm;TypeⅢ,acetabulum anterior column and( or) front wall fracture displacement more than 4 mm, wall column and ( or ) after fracture displacement more than 4 mm,top of the acetabulum fracture displacement more than 2 mm;TypeⅣ,double column or T fracture, fracture type central dislocation;TypeⅤ,acetabulum fracture combination of femoral neck fracture and( or) intra-articular loose bodies,pelvic fractures. Patients with Type Ⅰ and Ⅱ received conservative treatment, such as traction,patients with Type Ⅲ,Ⅳ,Ⅴ received anterior or posterior surgery. All patients were fol-lowed up for 6 months on average,and follow-up data was integrity. Harris score method was used to evalu-ate the function of hip joint. Results There was significant difference between X-ray and 3D model( P=0. 012),there was no significant difference between CT and 3D model(P=0. 083). Type Ⅰ was 3 cases,Type Ⅱ was 5 cases,Type Ⅲ was 16 cases,Type Ⅳ was 12 cases,Type Ⅴ was 10 cases. According to Harris score,excellent was 35 cases,good was 7 cases,fair was 4 cases,and the excellent and good rate was 91%;there was no significant difference in the long-term excellent and good rate of patients with TypeⅢ,Ⅳ,Ⅴ(P=0. 102,0. 079,0. 059). Conclusion The traditional Jndt and Letoume1 classification process is complicated and the angle has certain limitation,which has not considered the acetabulum weight-bearing area fracture,the joint free bone block as well as the head and neck,the pelvis fracture and so on. Three-di-mensional reconstruction spiral CT classification has some guiding significance for the clinical treatment of hip fracture.