The Value Of CT 3D Reconstruction In Intertrochanteric Fracture Classification And Treatment

Background:Intertrochanteric fracture is one of the most common fractures.Surgical failures caused by ineffective internal fixation often occurs in therapeutic practice.Improper selection of internal fixation materials is an important cause of ineffective internal fixation.Due to the limitations of radiographic examination,operator may choose wrong fixation because they lack of recognition of fracture.Therefore,radiographic examinations are very important for fracture classification and stability evaluation in treating intertrochanteric fracture.Compared with X ray,CT 3D reconstruction provides more imaging dimensions in facture examination,making it more intuitive and easier to understand.However,we still need data to further prove that CT 3D reconstruction is much better than X-ray in terms of consistency,classification accuracy and stability evaluation of intertrochanteric fracture.Objective:To explore the superiority of CT 3D reconstruction in consistency,classification accuracy and stability evaluation of intertrochanteric fracture.Methods:44 patients with intertrochanteric fracture were collected.Each doctor independently read preoperative X-ray films and performed classification by AO classification method,fracture stability evaluation and classification and stability evaluation.For cases with any inconsistency,three doctors jointly read their X-ray films and reached consistent agreement.Similarly,three doctors independently read preoperative CT 3D reconstruction films and performed classification by AO classification method,fracture stability evaluation and classification and stability evaluation.For cases with any inconsistency,three doctors jointly read their CT 3D reconstruction films and reached consistent agreement.Finally,the conclusion of these three doctors through common discussion based on X-ray were compared by the experimenter with that based on CT 3D reconstruction.For cases with different conclusions,these three doctors jointly read all preoperative and postoperative X-ray and CT 3D reconstruction images and obtained a consistent classification and stability evaluation conclusion.This conclusion together with the same conclusion based on X-ray and CT 3D reconstruction classification and stability evaluation were considered as the golden standard.The data were recorded by the experimenter.The two imaging methods were compared in terms of the classification consistency,classification accuracy and stability evaluation accuracy of the three doctors.Results:1.Consistency between observers(AO classification subtype):based on X-ray(kappa=0.28,0.64,0.53)and CT 3D reconstruction(kappa=0.57,0.67,0.72);the latter had a higher consistency than the former.2.Classification accuracy:the accuracy rates of AO classification by the three doctors based on X-ray were27.4%(12/44),43.2%(19/44)and 27.4%(12/44)respectively;the accuracy rates of AOclassification by the three doctors based on CT 3D reconstruction were 70.5%(31/44),88.6%(39/44)and 86.4%(38/44)respectively.The latter had much higher classification accuracy rates(all P<0.01),showing statistically significant differences.3.Stability evaluation accuracy:The instability rate based on X-ray were 45.5%(20/44),47.7%(21/44)and 29.5%(13/44)respectively.The instability rate based on CT 3D reconstruction were 79.5%(35/44),79.5%(35/44)and 77.3%(34/44)respectively.The instability rate of the golden standard was 79.5%(35/44).The instability rate based on X-ray by each doctor was much lower than that of the golden standard(all P<0.01),showing statistically significant differences.There were no statistically significant differences between the instability rate based on CT 3D reconstruction by each doctor and the golden standard(all P>0.05).Conclusion:CT 3D reconstruction is much better than X-ray in terms of consistency,classification accuracy and stability evaluation of intertrochanteric fracture.