多层螺旋CT三维重建工作原理及在胫骨平台骨折中的临床应用

Multislice spiral CT with three-dimensional reconstruction in the fractures of the tibial plateau

目的:探讨多层螺旋CT多平面重建和三维重建在胫骨平台骨折中的临床应用价值。资料来源:检索Medline1999-01/2006-12与多层螺旋CT多平面重建和三维重建及胫骨平台骨折相关文章。检索词:“SpiralCT;multiplanar reformation/3D surfacere construction;tibial plateau fractures”并限定文章语言种类为“English”。同时检索万方数据库1997-01/2006-12与多层螺旋CT多平面重建和三维重建及胫骨平台骨折的相关文章,限定文章语言种类为中文,检索词“螺旋CT多平面重建和三维重建,胫骨平台骨折”。资料选择:对资料进行初审,选择关于多层螺旋CT多平面重建和三维重建原理及其在胫骨平台骨折中临床应用的临床实验和观察性文章,无论有无对照组、是否随机分组均纳入,排除重复性观察和综述文章。资料提炼:共收集到106篇关于多层螺旋CT多平面重建和三维重建在胫骨平台骨折中的临床应用的随机和未随机的文章,33篇符合纳入文章,排除73篇文章,50篇为重复性观察,23篇为综述类文章。33篇中16篇介绍多层螺旋CT多平面重建和三维重建原理和特点,17篇探讨多层螺旋CT多平面重建和三维重建在胫骨平台骨折中的临床应用价值。资料综合:多层螺旋CT能高速完成较大范围的容积扫描,图像质量好,成像速度快,具有很高的纵向分辨率和很好时间分辨率,其影像后处理方法包括多平面重建、三维表面重建、最大密度投影、仿真内镜。多层螺旋CT多平面重建与三维重建成像相结合,能全面、准确显示胫骨平台骨折的类型,骨块移位的方向和平台塌陷的程度,对临床医生相应手术方案有重要指导意义。结论:多层螺旋CT多平面和三维重建后处理功能能直观的、整体的显示胫骨平台的骨折情况。准确判断骨折的形式和程度,有利于手术方案的拟定,在骨外科的应用具有广阔前景。

OBJECTIVE： To probe into the clinical application value of multislice spiral CT （MSCT） multiplanar reconstruction （MPR） and three-dimensional （3D） reconstruction in diagnosis and treatmentof tibial plateau fractures. DATA SOURCES： An online search of Medline database was undertaken by using the keywords of ＂spiral CT; multiplanar reformation/3D surface reconstruction; tibial plateau-fractures＂ to identify the relevant articles with MSCT MPR and 3D reconstruction in the treatfnent of tibial plateau fractures published in English from January 1999 to December 2006. Meanwhile, Wanfang database was scanned with computer to search relevant articles published from January 1997 to December 2006, the keywords were ＂spiral CT multiplanar reformation/3D surface reconstruction, tibial plateau fractures＂ with language limited to Chinese. STUDY SELECTION： The data were investigated primarily, clinical experiments and observational papers on clinical application of MPR and 3D reconstruction of MSCT in tibial plateau fractures were involved, regardless of the involvement in the control group and random grouping. The articles of repeated observation and reviews were excluded. DATA EXTRACTION： Totally 106 randomized or unrandomized articles about the clinical application of MPR and 3D reconstruction of MSCT in tibial plateau fractures were collected. And 33 of them met the inclusive criteria, 16 papers for the mechanism and characteristics of MSCT MPR and 3D reconstruction and 17 other papers for the clinical application of MPR and 3D reconstruction in the treatment of tibial plateau fractures. Other 73 articles were excluded, including 50 repeated articles and 23 reviews. DATA SYNTHESIS： MSCT presents good image quality, quick image taking speed, high longitudinal resolution and fine time resolution in a wide-range scanning, its image post-processing method is consisted of MPR, 3D surface reconstruction, maximum intensity projection and virtual endoscopy. MSCT MPR and 3D reconstruction help to classify fractures in tibial plateau and precisely measure cracks and collapses, contributing to planning a rational treatment. CONCLUSION： MPR and 3D reconstruction with MSCT can reveal tibial plateau fractures stereoscopically and intuitionistically. The accurate diagnosis on the fracture is beneficial for the operative proposal, indicating the widely application in orthopedic surgery.