CT扫描对胫骨平台骨折分型及治疗的影响

Effects of CT scan on classification and treatment of tibial plateau fractures

目的探讨CT扫描对胫骨平台骨折分型及治疗方法选择的影响。方法2003年2月～2004年5月对83例86侧胫骨平台骨折患者的临床资料进行分析。其中男53例,女30例;平均年龄43岁(17～63岁)。左55侧,右31侧,3例为双侧胫骨平台骨折。术前均摄正、侧位X线片及CT扫描。按照胫骨平台骨折Schatzker分型方法,对常规普通X线片与结合CT扫描的分型结果进行比较。同时发现并比较隐匿合并的胫骨髁间棘骨折及腓骨近端骨折。结果86侧中19侧(22.1%)参考CT扫描结果后更改分型,其中7侧(36.8%)更改内固定手术方法,占全部86侧骨折的8.1%。30侧胫骨髁间棘骨折及13侧腓骨近端骨折在常规X线片检查中未发现,后经CT扫描证实。各分型间合并胫骨髁间棘骨折及腓骨近端骨折的发生率差异无显著性意义(P>0.05)。结论CT扫描对胫骨平台骨折分型及治疗方法的选择具有重要影响。虽然会增加患者的治疗费用,但应作为术前常规检查加以应用。

Objective To study the effects of CT scan on treatment design and classification of tlbial plateau fractures, Methods From Fcbruary 2003 to May 2004, 86 fractures in 83 patients with tibial plateau fractures were treated in our department. Their clinical data were studied retrospectively. There were 53 males and 30 females. Their average age was 43 years with a span from 17 to 63 years. Fifty-five fractures were on the left side and 31 the right side, and three patients suffered bilateral tiblal plateau fractures. They all underwent anteroposterior and lateral radiography and CT scan. Their X-ray films and CT scans were both examined to find their fracture type according to the Schatzker＇s elassifieation system. The classification results of the two methods were compared to find the disparity and the hiding complicated fractures of proximal fibula and intereondylar eminence of the tibia. Results In this series, the classification for 19 fractures（22. 1% ） was corrected according to the CT findings. As a result, the initial internal fixation plan was changed for seven fractures of them （36.8 % ） . Thirty fi＇actures of intercondylar eminence of the tibia and 13 fractures of proximal fibula were not found on X-ray films but on CT scans. There was no statistical difference between the type of elasslfication and the incidence of complieated fractures of proximal fibula and intercondylar eminence of the tibia（ P 〉 0. 05） . Conclusion Although it is expensive, CT scan should serve as a routine examination before operation because it has significant effects on treatment plan and classification of tibial plateau fractures.