多层螺旋CT及其后处理技术在关节内骨折中的应用

Application of multi-slice spiral CT and postprocessing techniques in intra-articular fractures

目的:探讨多层螺旋CT(MSCT)及其后处理技术在关节内骨折诊断中的应用价值以及在评价关节面损伤细节方面的意义。方法:收集89例关节内骨折病人,均行X线平片及MSCT检查,并将MSCT容积扫描数据传至工作站,进行多平面重建(MPR)二维重建和容积再现(VR)三维重建。比较X线平片、MSCT及后处理图像对关节内骨折诊断的灵敏度以及对关节面损伤的细节评价。结果:MSCT轴位及MPR、VR图像诊断关节内骨折的灵敏度明显高于X线平片(P<0.0001)。在显示关节面断裂方面,MPR与X线平片、轴位CT及VR比较有非常显著性差异(P<0.01);在显示关节面塌陷方面,MPR及VR明显优于X线平片及轴位CT(P<0.0001);在显示关节内碎骨片方面,MPR及VR重建优于X线平片及轴位CT(P<0.05);在显示关节脱位方面,MPR及VR重建明显优于X线平片及轴位CT(P<0.01)。结论:尽管在骨关节损伤中,X线平片是首选的影像检查方法,但对不能肯定或排除关节内骨折的病人,应行MSCT检查,以提高诊断的正确性,避免误诊和漏诊。MSCT后处理技术可以有效评价关节内骨折及关节面损伤的细节,对关节内骨折的治疗有重要的指导意义。

Objective： To investigate the application of multi-slice spiral CT and postprocessing techniques in diagnosing intra-articular fractures, evaluate the value of detecting the injury details of articular surface. Methods： Eighty-nine cases of intra-articular fracture were studied. X-ray plain film and MSCT were taken in all patients. Their volume data of MSCT were transferred to workstation for multi-planar reconstruction（MPR） and volume rendering（VR）. The different methods were analyzed comparatively on their diagnostic sensitivity and evaluation of articular injury. Results：The diagnostic sensitivity of axial images, MPR and VR were all great higher than X-ray plain film（ P〈0. 0001）. On the performance of displaying articular surface rupture, MPR was significantly better than X-ray plain film,axial images and VR（ P〈0.01）. On displaying articular surface collapse, MPR and VR was significantly better than X-ray plain film and axial images（ P〈0. 0001）. On displaying bone fragment in the joint, MPR and VR were better than X-ray plain film and axial images（ P〈0.05）. On displaying articular dislocation, MPR and VR were significantly better than X-ray plain film and axial images（ P〈0.01）. Conclusion： Although X-ray plain film is the first imaging examination for osteoarticular trauma, in order to avoid misdiagnosis and missed diagnosis,MSCT is recommended in cases with equivocal diagnosis or in fear of intra-articular fractures. The postprocessing techniques of MSCT are not only useful to assess the details of intra-articular fracture and the injury of articular surface,but also is helpful in guiding treatment .