QCT辅助评价胫骨平台骨折形态的临床分析与应用研究  

QCT assisted clinical evaluation of fracture morphology of tibial platform by analysis and its application research

作　　者：高迪 刘定玺 许炜[3] 张清[3] 蒋国璋 程晓光[4] GAO Di;LIU Dingxi;XU Wei;ZHANG Qing;JIANG Guozhang;CHEN Xiaoguang(Department of Orthopedic,Puren Hospital of Wuhan,Wuhan,Hubei 430081,China;不详)

机构地区：[1]武汉市普仁医院(武汉科技大学附属普仁医院)骨科,湖北430081 [2]武汉科技大学冶金装备及其控制教育部重点实验室,湖北武汉430081 [3]武汉市普仁医院(武汉科技大学附属普仁医院)放射科,湖北430081 [4]北京积水潭医院放射科,北京100035

出　　处：《中国骨与关节损伤杂志》2024年第2期149-153,共5页Chinese Journal of Bone and Joint Injury

基　　金：中国金属学会冶金安全与健康分会健康卫生科研项目(jkws202086)。

摘　　要：目的通过地图投影技术及定量CT(Quantitative computed tomography,QCT)影像技术评估胫骨平台五柱分型下骨折形态、骨密度在临床诊疗上的价值。方法收集自2018-08—2022-07诊治的68例胫骨平台骨折的三维CT影像数据,应用Mimics 20.0软件重建健侧胫骨平台标准3D模型,对患侧骨折区域进行三维重建、复位,将复位的三维骨折模型导入3-matic软件中,在标准模型上识别骨折区域并叠加,应用MATLAB软件进行三维热图可视化处理。按照胫骨平台五柱分型,观察胫骨平台骨折区域三维图形在二维平面下各柱形态变化及骨折发生率,同时在健侧胫骨平台内外侧标记感兴趣区域,应用QCT准确获取骨密度值,对比内外侧柱骨密度值与骨折形态的相关影响。结果胫骨平台骨折三维重建结果显示胫骨平台前内侧柱骨折19例,占比27.94%;胫骨平台前侧柱(结节区域)骨折30例,占比44.11%;胫骨平台前外侧柱骨折53例,占比77.94%;胫骨平台后外侧柱骨折42例,占比61.76%;胫骨平台后内侧柱骨折24例,占比35.29%。骨折热图结果及分布比例显示前外侧柱及后外侧柱骨折分布为40%~70%,前内侧柱及后内侧柱骨折分布为20%~30%,前侧柱骨折分布为20%~40%。根据胫骨平台健侧内外侧骨密度测量结果,不同年龄段患者胫骨平台内侧骨密度高于胫骨平台外侧骨密度,其中50岁以上患者骨密度区别更加明显。结论QCT辅助评价胫骨平台骨折形态不仅完善了目前仅在理论上的五柱分型,同时提高了临床医师对其诊断的认识,并且指导临床手术规划,为临床制定个性化医疗提供依据。Objective To evaluate the value of fracture morphology and bone mineral density in the clinical diagnosis and treatment of tibial plateau five-column classification with map projection technology and quantitative computed tomography(QCT)imaging technology.Methods 3D CT image data of 68 cases of tibial plateau fractures diagnosed and treated from Au⁃gust 2018 to July 2022 were collected.The Mimics 20.0 software was used to reconstruct the standard 3D model of the healthy tibial plateau,and the affected fracture area was reconstructed and reduced in 3D,and the reduced 3D fracture model was im⁃ported into 3-matic software.The fracture area was identified and superimposed on the standard model,and the 3D heat map was visualized by MATLAB software.According to the five-column classification of the tibial plateau,the morphological chang⁃es and fracture incidence of the tibial plateau were observed in the two-dimensional plane of the three-dimensional pattern of the fracture region of the tibial plateau.At the same time,the areas of interest in the medial and lateral tibial plateau were marked on the healthy side,and bone mineral density(BMD)was accurately obtained by using QCT to compare the correlation between BMD and fracture morphology of the medial and lateral columns.Results The results of 3D reconstruction of tibial plateau fracture showed that 19 cases(27.94%)were anterior medial column fractures.The anterior lateral column of tibial pla⁃teau(nodular region)was fractured in 30 cases,accounting for 44.11%.There were 53 cases of anterolateral column fracture of tibial plateau,accounting for 77.94%.There were 42 cases of posterolateral column fracture of tibial plateau,accounting for 61.76%.There were 24 cases of posterior medial column fracture of tibial plateau,accounting for 35.29%.The results of frac⁃ture heat map and distribution ratio showed that the fracture distribution of anterolateral and posterolateral columns was 40%-70%,the fracture distribution of anterolateral and posterolateral columns was

关 键 词：胫骨平台骨折 定量计算机断层扫描技术 骨密度 地图投影技术 

分 类 号：R683.4[医药卫生—骨科学]