复杂髋臼骨折术中应用CT扫描的意义  

The significance of intraoperative computed tomograph scan for complex acetabular fractures

作　　者：许猛[1] 张立海[1] 张里程[1] 梁向党[1] 张明庆[1] 姚浙江[1] 唐佩福[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华骨科杂志》2011年第11期1261-1265,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨复杂髋臼骨折术中应用CT扫描的意义。方法2008年6月至2010年12月，结合术中CT监测治疗复杂髋臼骨折患者14例，男9例，女5例；年龄28-62岁，平均45．1岁。根据Le—toumel分型：后柱加后壁骨折2例，横行加后壁骨折4例，“T”形骨折2例，前柱加后半横行骨折3例，双柱骨折3例。其中合并髋关节后脱位3例，股骨骨折2例，跟骨骨折1例，L-骨折1例，坐骨神经损伤1例，颅脑损伤1例。术前采用X线片、CT三维重建对骨折进行评估，并使用三维影像处理软件进行术前计划。手术复位后临时固定，并使用“C”型臂X线机和CT扫描三维重建评估复位质量，对复位不满意者重新复位。再次行术中CT扫描三维重建检查内固定位置，并与术前计划对照。结果14例患者术中平均接受CT扫描2．7次，手术时间平均为40．4min，平均接受放射量约为47．2mGy。术中再行复位者4例，更改术前计划者1例。术后采用Matta影像学评价标准进行评估，优8例，良3例，差3例；优良率为78．6％。结论术中CT扫描三维影像监测增加了手术时间和患者放射线暴露，在评估复位质量方面与传统“C”型臂X线机相似，根据术中CT扫描三维重建结合术中情况实施手术与术前计划基本吻合。在术前使用X线片、CT三维重建对髋臼骨折进行仔细评估的前提下，术中使用CT三维影像监测是否有利于提高手术成功率减少手术并发症尚有待进一步商榷。Objective To investigate the application of intraoperative Computed Tomograph （CT） using in surgery for complex acetabular fractures. Methods From June 2008 to December 2010, 14 patients （9 males, 5 females; with the mean age of 45.1 years; range, 28-62 years） with complex acetabular fractures were operated using intraoperative CT. Preoperative radiotherapy and CT scan were adopted to evaluate the fractures. Three dimensional reconstruction based on CT scan was used to mimic surgery. The surgery approach and the type of internal fixators were noted. Intraoperative C-arm and CT scan were used to evaluate the fractures reduction respectively. Decision of additional reduction was made by surgeons according to above mentioned methods respectively and the results were noted. Comparing to preoperative design, the change of surgery plan were noted. Overall time, frequency and radiation dose of intraoperative CT scan were also noted. Results All patients in this study received average 2.7 times of intraoperative CT scan. Mean time of CT scan was 40.4 rain and the overall dose of radiation was 47.2 mGy. Decision of additional reduction was made in 3 cases according to C-arm radiography and 4 cases according to CT scan （above mentioned 3 cases were included）. The change of surgery plan was made in one case. In postoperative radiography evaluation according to Matta＇s score system, anatomical reduction were achieved in 8 cases, imperfect reduction in 3 cases and poor reduction in 3 cases. Conclusion Intraoperative CT scan increases the radiation time and dose of patients dramatically. When used to evaluate fracture reduction intraoperatively, it can＇t take the advantage of traditional C-arm radiography. When delicate preoperative plan is made with radiography and three dimensional reconstruction based on CT data, the efficiency of intraoperative CT scan for complex acetabular fractures are to be discussed.

关 键 词：髋臼 骨折 外科手术 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]