基于X线片与CT的不稳定型骨盆骨折3D分型研究  

3D classification of unstable pelvic fractures based on X-ray and CT images

作　　者：高金华[1] 郭晓山[2] 梁清宇[1] 黄俊武[2] 石成弟[2] 

机构地区：[1]安徽省芜湖市中医院骨科,241000 [2]温州医学院附属第二医院骨科

出　　处：《中华创伤骨科杂志》2013年第11期961-966,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨基于X线片与CT的不稳定型骨盆骨折3D分型，以指导临床实践。方法回顾性分析2005年3月至2009年8月收治的51例不稳定型骨盆骨折患者资料，包括X线片、CT二维及三维图片，回顾其手术复位过程，结合骨盆骨折3D数字模型模拟其移位过程进行分类，得出相应的3D模型及移位方式。截取骨盆尸体标本的骨折模型，模仿其移位方式，分别摄片予以对照验证。结果不稳定型骨盆骨折按其移位方向可以在3D空间内将其分为17型：1D空间移位：上移、外翻、内翻、前旋、后旋，2D空间移位：上移外翻、上移内翻、上移前旋、上移后旋、前旋外翻、前旋内翻、后旋外翻、后旋内翻，3D空间移位：外翻前旋上移、外翻后旋上移、内翻前旋上移、内翻后旋上移。对51例不稳定型骨盆骨折患者影像学资料进行3D分型的可靠性评价：Kappa值平均为0．549，属于中度可信度。结论骨盆骨折的3D分型是基于骨盆骨折的Tile分型、Burgess和Young分型及AO分型的一种空间分型，能够较准确地确定骨折的各向移位，可为骨盆骨折的手术复位提供精确指导。Objective To investigate the feasibility and clinical value of 3D classification of un- stable pelvic fractures based on X-ray and CT images. Methods A retrospective view was conducted of all, the clinical data of 51 unstable pelvis fractures from March 2005 to August 2009 in our hospital, including their X-rays, two dimensional （2D） and three dimensional （3D） CT scans, and their reduction approaches. The displacements and fractures of the 51 patients were respectively simulated in a digital 3D model of the normal pelvis for classification. The digital 3D models of pelvic fractures and displacements obtained were correspondingly recreated and tested in a cadaveric specimen of the normal pelvis. Pictures of the digital 3D models were compared with the corresponding photos of the cadaverie models respectively. Results Altogether 17 types of pelvic ractures were identified. In the 1D space, there were upper displacement, eversion, inversion, pronation and supination. In the 2D space, there were upper displacement eversion, upper displacement inversion, upper displacement pronation, upper displacement supination, pronation eversion, pronation inversion, supination eversion, and supination inversion. In the 3D space, there were evasion pronation upper displacement, ev- ersion supination upper displacement, inversion pronation upper displacement, and invezion supination upper displacement. The inter-observer reliability using the 3D classification in the 51 patients with unstable pelvic fracture was moderate （Kappa = 0. 549）. Conclusions The 3D classification system of pelvic fractures is based on Burgess and Young, Tile and AO classifications. It can help orthopaedists accurately determine the displacement in an unstable pelvic fracture, and can provide precise evidence for operative lduction of the fracture.

关 键 词：骨盆 骨折 X线 体层摄影术 X线计算机 分型 

分 类 号：R687.3[医药卫生—骨科学]