基于增强CT和MRN的三维图像拟合技术对骨盆骨折合并腰骶丛损伤的诊疗价值  

Application of 3D image fusion technique of enhanced CT and magnetic resonance neurography on pelvic fractures with lumbosacral plexus injury

作　　者：陈煜辉 张晓东 王见 陈焱君 麦奇光 李涛 廖坚文 樊仕才 Chen Yuhui;Zhang Xiaodong;Wang Jian;Chen Yanjun;Mai Qiguang;Li Tao;Liao Jianwen;Fan Shicai(Department of Traumatic Surgery,Center for Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Department of Radiology,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院骨科中心创伤骨科,广州510630 [2]南方医科大学第三附属医院影像科,广州510630

出　　处：《中华骨科杂志》2022年第10期609-617,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81772428、82072411);广东省科技计划项目(2017B090912006)。

摘　　要：目的探讨骨盆增强CT联合磁共振神经成像(magnetic resonance neurography,MRN)的三维图像拟合技术在骨盆骨折合并腰骶丛损伤中的诊疗价值。方法回顾性分析2019年1月至2020年12月接受骨盆增强CT联合MRN三维图像拟合技术辅助诊断的15例骨盆骨折合并腰骶丛损伤患者资料,男11例、女4例;年龄(26.67±11.34)岁;骨盆骨折AO分型:C1.3型11例、C2型2例、C3型2例。所有患者均有下肢神经功能障碍,根据英国医学研究会运动功能等级评定标准,踝背伸肌肌力3级1例、2级7例、1级5例、0级2例。通过体格检查及增强CT联合MRN三维图像拟合技术对腰骶丛损伤部位、神经损伤性质、骨折移位、血管和输尿管走行方向进行精准判断,制定相应的手术方案。前方入路切开复位内固定及神经减压术后随访时评估患者神经功能恢复情况。结果15例患者均顺利完成手术。术中腰骶丛损伤部位与术前拟合图像诊断均相符;神经损伤性质判断中有4例不符(4/15,27%),6例腹腔镜下神经减压手术中2例因神经松解困难而改为开放手术。4例采用腹腔镜手术,手术时间(116.27±26.46)min,术中出血量(102.50±79.32)ml;11例采用开放手术,手术时间(123.64±38.28)min,术中出血量(713.64±393.12)ml,其中9例成功松解减压、2例探查发现神经完全断裂。15例患者均获得随访,随访时间(9.33±2.19)个月;末次随访时均观察到影像学上的骨性愈合,愈合时间(5.03±1.04)个月(范围3~6个月)。末次随访时患者踝背伸肌肌力5级8例、4级3例、3级1例、2级1例、0级2例,与术前比较差异有统计学意义(Z=3.27,P<0.001);感觉功能评定标准:S4级8例、S3+级1例、S3级3例、S2级1例、S0级2例。结论增强CT联合MRN三维图像拟合技术术前可对骨盆骨折合并腰骶丛损伤进行准确定位和定性,精确指导手术方案制定,减少手术创伤与相关并发症。Objective To investigate the application of three-dimensional(3D)image fusion technique of pelvic enhanced CT and magnetic resonance neurography(MRN)on the patients of pelvic fractures with lumbosacral plexus injury.Methods From January 2019 to December 2020,15 patients 11 males,4 females,mean age 26.67±11.34 of pelvic fracture(AO classification C1.3 of 11 cases,C2 of 2 cases,C3 of 2 cases)with lumbosacral plexus injury underwent 3D image fusion of pelvic enhanced CT and MRN.All patients exhibited lower limb nerve dysfunction after injury.The preoperative muscle strength were evaluated by British Medical Research Council(BMRC)criteria:grade 0 in 2 cases,grade 1 in 5,grade 2 in 7 and grade 3 in 1.Physical examination and enhanced CT combined with MRN 3D image fusion technology were used to accurately determine the injury site of lumbosacral plexus nerve,fracture displacement,and the direction of blood vessels and ureters,and develop corresponding surgical plans.The neurological functions were measured in post-operation follow-up.Results All 15 operations were successfully completed and the site of lumbosacral plexus injury during operation was consistent with preoperative fusion image,and inconsistency of injury characteristic in 4 patients(4/15,27%).Among the 6 cases of laparoscopic surgery,2 cases were changed to open surgery because of the difficulty of nerve decompression.The average time of 4 cases of laparoscopic surgery was 116.27±26.46 min and intraoperative blood loss was 102.50±79.32 ml.The average time of 11 cases of open operation was 123.64±38.28 min,and intraoperative blood loss was 713.64±393.12 ml.For the opening operations,9 cases were successfully decompressed,and nerve disruption was observed in 2 patients.All 15 patients were followed up.The average follow-up time was 9.33±2.19 months.The radial bony healing was observed in each case at the end of follow-up,mean healing time was 5.03±1.04 months(range,3-6 months).In addition,patients'muscle strength recovered,8 cases of grade 5,3 cases o

关 键 词：骨盆 骨折 磁共振成像 体层摄影术 X线计算机 腰骶丛 

分 类 号：R687.3[医药卫生—骨科学]