一种新的基于CT图像的寰椎骨折分型方法及其应用  

A new classification of atlas fracture based on CT reconstruction and its clinical significance

作　　者：蒋伟宇[1] 路文杰 陈云琳[1] 胡旭栋[1] 王扬[1] 阮超越 许楠健[1] 徐荣明 马维虎[1] Jiang Weiyu;Lu Wenjie;Chen Yunlin;Hu Xudong;Wang Yang;Ruan Chaoyue;Xu Nanjian;Xu Rongming;Ma Weihu(Department of Spinal Surgery,the Sixth Hospital of Ningbo,Ningbo 315040,China;The Second Clinical College of Zhejiang Chinese Medicine University,Ningbo 310053,China;Department of Orthopaedics,Zhejiang University Mingzhou Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院脊柱外科,宁波315040 [2]浙江中医药大学第二临床医学院,宁波310053 [3]浙江大学明州医院骨科,宁波315040

出　　处：《中华骨科杂志》2023年第11期712-719,共8页Chinese Journal of Orthopaedics

基　　金：浙江省自然科学基金(LY18H060007);浙江省医药卫生科技计划(2021KY328)。

摘　　要：目的探讨一种新的基于寰椎骨折治疗前后CT影像特征的寰椎骨折分型方法在临床诊断与治疗中的意义。方法回顾性收集2015年1月至2020年12月于宁波市第六医院诊治的75例寰椎骨折患者,男44例、女31例,年龄(53.3±13.0)岁(范围27~81岁)。依据Landells分型,Ⅰ型12例、Ⅱ型13例、Ⅲ型33例,骨折位于解剖交界处难以分型9例,因受伤暴力多样化而无法套用Landells分型8例。根据CT图像中寰椎骨折线是否累及寰枢侧块关节面、是否累及双侧半环和骨折断端移位距离,初步建立新的寰椎骨折分型。随机选取5名脊柱外科医生,依据新的分型方法对75例患者的CT图像进行分型;于1个月后将75例寰椎骨折的影像学资料顺序打乱,再次进行分型,评估分型的可靠性和可重复性。结果新的寰椎骨折分型方法:首先根据骨折线是否累及寰枢侧块关节面分为三型,A型为骨折线未累及寰枢侧块关节面,B型为骨折线累及一侧寰枢侧块关节面且对侧半环完整,C型为骨折线累及一侧寰枢侧块关节面伴对侧半环任何部位骨折;再根据骨折断端间最大移位距离是否超过4 mm分为六个亚型,≤4 mm为1型,>4 mm为2型,即A1、A2、B1、B2、C1、C2。75例患者按新的寰椎骨折分型方法:A1型17例,A2型12例,B1型7例,B2型13例,C1型12例,C2型14例。5名医生对该分型的可信度和可重复性Kappa值分别为0.85和0.91,达到完全可信范围。末次随访时保守治疗患者均达到骨愈合;手术治疗者中4例骨折断端不愈合但寰枢椎间融合良好,其余患者均获得骨性愈合,且无内固定松动、断裂等并发症。结论基于寰椎骨折的CT影像特征提出新的寰椎骨折分型方法能够基本涵盖临床常见寰椎骨折病例,且一致性较好,对寰椎骨折的诊断与治疗有一定的临床指导意义。Objective To investigate the clinical significance of a new classification system for atlas fractures based on pre-and post-treatment CT features,with a focus on diagnosis and treatment.Methods A retrospective analysis was conducted on 75 cases of cervical vertebra fractures treated at the Sixth Hospital of Ningbo City between January 2015 and December 2020.The study included 44 males and 31 females,with an average age of 53.3±13.0 years(range:27-81 years).The fractures were classified according to the Landells classification,resulting in 12 cases of type I,13 cases of type II,33 cases of type III,9 cases that were difficult to classify due to fracture lines located at anatomical junctions,and 8 cases that could not be classified using the Landells classification due to diverse injury mechanisms.To establish a new preliminary classification for cervical vertebra fractures,the researchers considered whether the fracture line in the CT images involved the facet joint surface of the atlas,the impact on bilateral half-rings,and the displacement distance of the fracture ends.Five spinal surgeons were randomly selected to classify the CT images of the 75 patients using the new classification method.After one month,the imaging data of the 75 cases of cervical vertebra fractures were randomized and reclassified to assess the reliability and repeatability of the classification.Results The new cervical vertebra fracture classification method comprised three types based on whether the fracture line involved the facet joint surface of the atlas:type A(no involvement of the facet joint surface of the atlas),type B(involvement of one side of the facet joint surface with intact contralateral half-ring),and type C(involvement of one side of the facet joint surface with fractured contralateral half-ring).Additionally,based on the maximum displacement distance between the fracture ends(>4 mm),six subtypes were identified:subtype 1(≤4 mm displacement)and subtype 2(>4 mm displacement).Consequently,the subtypes were classified as

关 键 词：颈寰椎 骨折 体层摄影术 螺旋计算机 

分 类 号：R683[医药卫生—骨科学] R816.8[医药卫生—外科学]