三维CT重建技术术前评估粉碎性跟骨骨折的效果研究  

Comminuted Calcaneal Fractures with Three-Dimensional CT Reconstruction Before Surgery Evaluation

作　　者：陈文敏 曾佑兰 肖路平 CHEN Wen-min;ZENG You-lan;XIAO Lu-ping(Department of Radiology,Shangyou County Hospital of Traditional Chinese Medicine,Shangyou 341200,Jiangxi Province,China)

机构地区：[1]上犹县中医院放射科,江西上犹341200

出　　处：《罕少疾病杂志》2022年第8期97-99,共3页Journal of Rare and Uncommon Diseases

基　　金：江西省赣州市指导性科技计划项目(GZ2021ZSF440)。

摘　　要：目的探讨基于三维CT重建术前评估术前评估粉碎性跟骨骨折的实际临床效果。方法选取2020年4月至2022年3月期间我院诊治的疑似粉碎性跟骨骨折患者371例,随机数法进行人员编排,随机分为三维CT重建组(3D-CT组,n=185例)、X线组(X-Rale组,n=186例),针对骨折部位,两组分别给予三维重建扫描检测及X线照射检测,依据跟骨骨折Stephens-Sanders分型分为3个亚组,即Stephens-SandersⅠ亚组、Stephens-SandersⅡ亚组、Stephens-SandersⅢ亚组。记录3D-CT组、X线组及其亚组,手术前后Maryland足部评分变化;观察两组关节面塌陷骨折、负重区骨质缺损、载距突骨折的阳性检出率。ROC曲线对两组术前评估粉碎性跟骨骨折诊断效能,ACU>0.70视为具备术前评估能力。结果治疗后,与X-Rale组相比,3D-CT组Maryland足部功能评分具备明显统计学差异(t=12.555,P=0.025<0.05),同样,在各亚组横向比较中,同样具备统计学差异(P均<0.05,其中:PⅠ组=0.020;PⅡ组=0.004;PⅢ组=0.001)。三维CT组的阳性检出率为76.60%,远高于X-Rale组的38.64%,在塌陷骨折中,两组未见明显差异性(t=0.354,P=0.707>0.05);在负重骨缺损及载距突骨折检出率比较中,两组则具备明显差异性(P=0.009,P<0.001),3D-CT扫描,其AUC=0.722,特异度68.42%,准确性92.39%,具备检测效能。结论基于三维CT重建术前评估跟骨骨折安全有效,有望成为治疗手术跟骨粉碎性骨折的理想检测方式,值得临床推广。Objective Investigate the clinical effect of preoperative evaluation of comminuted calcaneal fractures based on THREE-DIMENSIONAL CT reconstruction.Methods A total of 371 patients with suspected comminted calcaneal fractures in our Hospital from April 2020 to March 2022 were selected and randomly divided into 3D-imensional CT reconstruction group(3D-CT group,n=185cases)and X-ray group(X-RALE group,n=186cases).The two groups were given 3D reconstruction scanning and X-ray radiation detection respectively.According to the classification of calcaneal fracture,they were divided into 3 subgroups,namely,Stephens-SandersⅠsubgroup,Stephens-SandersⅡsubgroup and Stephens-SandersⅢsubgroup.Maryland foot score before and after operation was recorded in 3D-CT group,X-ray group and subgroup.The positive detection rates of articular surface collapse fracture,bone defect in weight-bearing area and talus process fracture were observed.ROC curve was used to evaluate the diagnostic efficacy of comminution calcaneal fracture in the two groups before operation,and ACU>0.70 was considered as having the ability of preoperative evaluation.Results After treatment,compared with the X-RALE group,the Maryland foot function score in the 3D-CT group had significant statistical difference(t=12.555,P=0.025<0.05),and also had statistical difference in the cross-sectional comparison among the subgroups(all P<0.05,PⅠgroup=0.020;PⅡgroup=0.004;PⅢgroup=0.001).The positive detection rate of 3D CT group was 76.60%,much higher than that of X-RALE group(38.64%).There was no significant difference in collapse fracture between the two groups(t=0.354,P=0.707>0.05).In the comparison of the detection rate of weight-bearing bone defect and talar process fracture,there was significant difference between the two groups(P=0.009,P<0.001).The AUC of 3D CT scan was 0.722,with specificity of 68.42%and accuracy of 92.39%,showing detection efficiency.Conclusion Preoperative evaluation of calcaneal fracture based on THREE-DIMENSIONAL CT reconstruction is safe

关 键 词：粉碎性骨折 跟骨骨折 三维CT重建 术前评估 

分 类 号：R683[医药卫生—骨科学]