CT三维重建技术在踝关节骨折术后评估中的应用价值  

Application of three-dimensional CT reconstruction in postoperative evaluation of ankle fracture

作　　者：张坤[1] 陈雁西[1] 强敏菲[1] 李浩博[1] 戴号[1] 

机构地区：[1]同济大学附属东方医院创伤骨科同济医院医学研究所,上海200120

出　　处：《中华创伤骨科杂志》2013年第12期1024-1028,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81271989,81000818）

摘　　要：目的分析CT三维重建技术在踝关节骨折术后评估中的应用价值。方法2009年5月至2012年6月收治168例踝关节骨折患者，男99例，女69例；年龄21～75岁，平均47．5岁；损伤按Lauge—Hansen分型：旋后外旋型（SER）85例，旋后内收型（SAD）32例，旋前外旋型（PER）27例，旋前外胰型（PAB）24例；均为闭合性骨折，采用通用手术方案治疗。术后摄踝关节正、侧位X线片及CT片，采用容积币建法内置入物透视显示模式结合多平晰重组成像模式观察骨折复位质量及内固定置入情况，并将CT与X线片观察结果进行对比分析。结果术后在SER、SAD、PER及PAB损伤中，x线片分别可见6、1、2、2例患者未达到解剖复位，而CT三维重建图像分别可见36、12、8、3例患者末达到解剖复位，X线和CT在评估SER、SAD、PER及所有患者时差异均有统计学意义（P〈0．05）。在内固定置入质量评估上X线片分别可见2、1、0、0例患者螺钉位置欠佳，而CT三维重建图像分别可见8、8、3、4例患者的螺钉位置欠佳，x线和CT在评估SER、SAD及所有患者时差异均有统计学意义（P〈0．05）。结论踝关节骨折术后通过CT三维重建图像进行复位质最及内固定置入质量的评估能够扶得比x线片评估更加可靠的结果。Objective To analyze the application of three-dimensional CT reconstruction in post- operative evaluation of ankle fracture. Methods The data of 168 patients with ankle facture from May 2009 to June 2012 were analyzed. According to Lauge-Hansen classification, there were 85 cases of supina- tion-external rotation （SER）pattern, 32 supination-adduction （SAD）pattern, 27 prunalion-external rotation （PER） pattern and 24 pronation-abduction （PAB） pattern. They were all closed fractures and conventional operations were performed within 2 weeks. Postoperative antero-posterior and lateral radiographs and 16-slice spiral CT scan images were studied to evaluate fracture reduction and implant placement using the volume rendering mode and muhiplanar reconstruction mode. The CT scans were then compared with radiographs. Results Radiographs revealed non-anatomic reduetion in 6. 1, 2 and 2 patients in groups SER, SAD, PER anti PAB respectively, while CT scan images did in 36, 12, 8 and 3 patients in the 4 groups respec- tively. Significant differences between CT scans and radiographs were observed in groups SER. SAD and PER. as well as in the overall evaluation （ P 〈 0.05）. As tor implant placement, radiographs revealed poor impla,ltation in 2, 1, 0 and 0 patienls in groups SER, SAD, PER and PAB respectively, while CT scan images did in 8, 8, 3 and 4 patients in the 4 groups respectively. Significant differences between CT scans and radiographs were observed in groups SER and SAD, as well as in the overall evaluation （ P 〈 0.05）. Conclusion Three-dimensional CT reconstruction may be more reliable than radiographs in the postoperative evaluation of reduction and implant placement for ankle fractures.

关 键 词：踝关节 骨折 骨折固定术 内 成像 三维 

分 类 号：R687.3[医药卫生—骨科学]