改良螺旋CT多平面重组技术在肱骨近端骨折Neer分型中的应用及诊断一致性研究OA

Objective:To investigate application value of multi-planar reconstruction(MPR)technique of modified spiral computed tomography(CT)in Neer classification of proximal humeral fractures,and to assess diagnostic consistency and clinical application value of that,so as to optimize assessment processes of imaging.Methods:A total of 120 patients with proximal humeral fractures from Chongqing Hospital,The First Affiliated Hospital of Guangzhou University of Chinese Medicine(Beibei District Hospital of Traditional Chinese Medicine of Chongqing Hospital)between January 2023 and January 2025 were enrolled in this study.The prospective randomized controlled design was adopted to divided patients into an observation group(n=60)that received personalized oblique MPR reconstruction of modified MPR technique,and a control group(n=60)that received conventional MPR technique to conduct MPR reconstruction at standard sagittal,coronal,and axial positions.The intraoperative records of the amount of fracture fragments,and the degree of displacement under intraoperative direct visualization were used as the gold standard.The diagnostic conformity rate(including accuracy,sensitivity and specificity),inter-observer consistency(assessment with Kappa values),intra-observer consistency[assessment with intra-group correlation coefficient(ICC)],the time-consuming of CT post-processing,the scores of confidence level of diagnosis(using a 5-point Likert scale),and Constant-Murley shoulder joint function score at the 6th month postoperative surgery between two groups were compared.Results:The diagnostic accuracy(90.00%)of observation group was significantly higher than 80.00%of control group,with a statistically significant difference(x2=4.800,P<0.05).Inter-observer consistency(Kappa value)and intra-observer consistency(ICC value)of observation group were significantly higher than those of control group,with statistically significant differences(t=9.231,11.000,P<0.001).The time-consuming of CT post-processing of observation group was shorter than that of control group,with a statistically significant difference(t=-10.200,P<0.001).The scores of confidence level of diagnosis of observation group was higher than that of control group,with a statistically significant difference(t=6.667,P<0.001).Postoperative function scores about pain,activities of daily living,range of motion,muscle strength,and total score of observation group were significantly better than those of control group,and the differences of them between two groups were significant(t=5.882,4.286,4.615,4.444,7.501,P<0.001).Conclusion:The modified MPR technique can significantly increase diagnostic accuracy,consistency of observers,and confidence of physicians in diagnosis for Neer classification of proximal humeral fractures,and shorten the processing time for images,which contributes to improve prognosis of the functions of patients.