目的探讨CT三维重建在股骨转 子间骨折分型中的应用价值。方法 收集 72例股骨转子间骨折患者，由三位医师分 别单独进行X线、CT三维重建图像阅片， 并根据AO分型标准进行骨折分型与稳定 性评估，对于基于X线与CT三维重建下各 医师诊断不一致病例，经讨论分别得到统 一结论；对于基于X线的统一结论与基于 CT三维重建的统一结论不一致病例，进行 讨论取得一致结论，作为金标准；分析基 于X线或CT三位重建下三位医师进行骨折 分型的一致性，并比较两种影像学方法骨 折分型及稳定性评估准确度。结果 对于 AO分型亚型，三位医师基于CT三维重建 的骨折AO分型一致性(kappa值为0.49、 0.76、0.77)，优于基于X线的骨折AO分型 一致性(kappa值为0.26、0.62、0.51)。 三位医师基于CT三维重建进行骨折分型的 统一结论诊断准确度为90.28%(65/72)， 较基于X线进行骨折AO分型统一结论的 44.44%(32/72)明显增高(P <0.05)。三位 医师基于X线进行骨折分型统一结论中不 稳定型骨折比例为40.28%(29/72)，明显 低于金标准的79.16%(57/72)(P<0.05)； 而三位医师基于三维CT进行骨折分 型的统一结论中不稳定型骨折比例为 77.78%(56/72)，与金标准比较差异无统 计学意义(P>0.05)。结论 在股骨转子间 骨折分型一致性、准确度和稳定性评估 上，CT三维重建均要优于X线。

Objective To investigate the value of three-dimensional CT reconstruction in the classification of femoral intertrochanteric fractures. Methods A total of 72 patients with femoral intertrochanteric fractures were collected. The images of X-ray and CT threedimensional reconstruction were read by three doctors separately. Fracture classification and stability assessment were performed according to the AO classification criteria. For cases with inconsistent results diagnosed by each physician based on X-ray and threedimensional CT reconstruction, a unified conclusion was drawn after discussion. For cases with unified conclusion based on X-ray which was inconsistent with that based on threedimensional CT reconstruction, a unified conclusion was drawn after discussion, and it was taken as the golden standard. The consistency of fracture classification performed by three physicians based on X-ray or three-dimensional CT reconstruction was analyzed, and the accuracy of fracture classification and stability assessment was compared between the two imaging methods. Results For AO subtypes, the kappa values of fracture AO classification by three physicians based on three-dimensional CT reconstruction were 0.49, 0.76 and 0.77, respectively, which were better than those of X-ray (0.26, 0.62, 0.51). The accuracy of fracture classification by three physicians based on three-dimensional CT reconstruction was significantly higher than that based on X-ray [90.28% (65/72) vs 44.44% (32/72)] (P<0.05). The proportion of unstable fractures diagnosed by the three physicians based on X-ray findings was significantly lower than that based on the golden standard [40.28% (29/72) vs 79.16% (57/72)] (P<0.05). The proportion of unstable fractures diagnosed by the three physicians based on three-dimensional CT was 77.78% (56/72), and there was no significant difference compared with the golden standard (P>0.05). Conclusion The three-dimensional CT reconstruction is superior to X-ray in the consistency, accuracy and evaluation of stability of intertrochanteric fractures.