基于CT三维重建的髋臼方形区骨折线的初步研究  

Study of fracture lines in the quadrilateral surface of the acetabulum based on three-dimensional computerized tomography reconstruction

作　　者：高波华 王钢[1] 卢超[1] 宋迎春[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华创伤骨科杂志》2014年第4期305-310,共6页Chinese Journal of Orthopaedic Trauma

基　　金：AO创伤亚太研究基金（AOTAP10-04）;国家自然科学基金（81272008）;广州市科技计划项目（2013J4100104）;广东省自然科学基金（10151051501000085）

摘　　要：目的通过cT三维重建对髋臼方形区骨折线进行观察和创新性描述，探讨其方形区骨折线走行与髋臼骨折Judet．Letournel分型的关系。方法收集2001年1月至2013年11月行CT平扫和三维重建的171例（173侧）患者资料，将方形区骨折线标记为“四边形”进行描述，将弓状缘定义为近似斜线，根据前、后、左、右的方位，总结出6条基本的单骨折线：上横形、下横形、顺斜形、逆斜形、前竖形、后竖形，与髋臼骨折Judet。letoumel分型进行综合分析，了解二者的相互关系。结果累及前柱的骨折线类型（194条）中，横形线占34．5％（67／194）、斜形线占48．5％（94／194）、竖形线占17．0％（33／194）；累及后柱的骨折线类型（200条）中，横形线占33．5％（67／200）、斜形线占49．5％（99／200）、竖形线占17．0％（34／200）；同时累及前柱和后柱的骨折线（170条）中，横形线占37．1％（63／170）、斜形线占48．2％（82／170）、竖形线占14．7％（25／170）。累及前柱、后柱的骨折线以上横形和顺斜形为主，累及到前柱的顺斜形骨折线往往位置较高，常位于弓状缘周围。结论对方形区骨折线的创新性描述可加强对Judet．Letoureel分型的认识，对髋臼骨折的手术入路选择、复位技巧及内固定方式的选择可能有指导意义。Objective To analyze relationships between fracture lines in the acetabular quadrilateral surface and Judet-Letournal classification of acetabular fractures through three-dimensional reconstruction of computerized tomography of acetabular fractures, Methods From January 2001 to November 2013, three-dimensional CT reconstruction data of the pelvis were collected for this study from 171 patients with acetabular fracture involving 173 hips. The fractures were classified according to Judet-Letoumel classification. The fracture lines in the quadrilateral surface were observed and categorized into 6 kinds according to the directions of their courses： upper transverse, lower transverse, cis-oblique, trans-oblique, anterior vertical and posterior vertical. The relationships between the 6 kinds of fracture line and the Judet-Letournel classifications of the acetabular fractures were analyzed. Results In the fractures involving merely the anterior or posterior column, transverse fracture lines accounted for 33.5% （67/200） and 34.5% （67/194）, oblique ones for 49. 5% （99/200） and 48.5% （94/194）, vertical ones for 17.0% （34/200） and 17.0% （33/194）, respectively. In the fractures involving both anterior and posterior columns, transverse fracture lines accounted for 37. 1% （63/170）, oblique ones for 48.2% （82/170）, and vertical ones for 14. 7% （25/170）. The fracture lines involving the anterior column and posterior column are chiefly upper transverse and cis-oblique ones; the cis-oblique fracture lines involving the anterior column are often in a high position, located around the linea terminalis. Conclusions This new characterization of the fracture lines in the quadrilateral surface may help better understand the Judet-Letournal classification of acetabular fractures. Awareness of these characteristics may help choice of surgical approaches, reduction and internal fixation in the treatment of acetabular fractures.

关 键 词：髋臼 成像 三维 骨板 骨折线 

分 类 号：R687.3[医药卫生—骨科学]