16层螺旋CT的后处理功能在复杂骨关节骨折诊断中的应用价值

The application of postproccessing technique with 16-SCT in diagnosis of complex bone and joint fracture

目的探讨16层螺旋CT(16-SCT)及其多平面重建(MPR)、三维表面重建(SSD)、容积重建(VR)等重建技术在复杂骨关节创伤性骨折中的诊断及临床应用价值。方法收集创伤性骨折100例,包括胫骨平台骨折30例,髋臼骨折30例,脊柱骨折30例,踝关节骨折10例。所有病例均经DR检查和16-SCT检查。16-SCT扫描后,在工作站上行MPR、SSD和VR重建。结果100例骨折共检出308处骨折线。DR检出239处,检出率77.6%;16-SCT横轴位检出301处,检出率97.7%;MPR检出308处,检出率100%;SSD检出246处。检出率79.9%;VR检出279处,检出率90.6%。在骨折分型上,DR有21例诊断错误,包括:胫骨平台骨折9例,髋臼骨折8例,脊柱骨折4例。在检出骨折线数量方面,16-SCT横轴位、MPR、VR与DR比较,差异均有统计学意义(P均<0.05),SSD与DR差异无统计学意义(P>0.05);在骨折分型诊断方面,16-SCT轴位图像及其MPR、SSD、VR等重建技术明显优于DR。结论16-SCT的轴位、MPR、VR图像在显示骨折线及骨折分型诊断方面明显优于DR,在创伤性骨折的诊断和临床治疗中具有其他影像方法不能替代的作用。

Objective To discuss the clinical application of MPR, SSD and VR postprocessing techniques with 16-SCT in diagnosis of bone and joint trauma. Methods One hundred eases of trauma which included tibial plateau fracture （30 cases）, acetabular fracture （30 cases） ,spine fracture（30 eases） and ankle fracture（ 10 cases） were examed with Siemens Somatom Sensation 16 and DR. In these cases there were 69 cases males and 31 cases females with 19 to 78 years old（ mean was 39. 5 years old）. After examed with 16-SCT,these datas were reconstructed in workstation with MPR, SSD and VR techniques. Results For 100 cases of fractures, the detected fracture quantity of DR, axial images, MPR, SSD and VR was 239,301,308,246 and 279 respectively. Fracture detection rate of X-ray, axial, MPR, SSD and VR were 77. 6%, 97.7%, 100% ,79. 9% and 90. 6% respectively. DR misclassified 21 cases that included 9 cases of tibial plateau fracture,8 cases of acetabular fracture and 4 cases of spine fracture. The fracture detection quantity with axial images,MPR and VR were statistically different to that with DR （ P 〈0. 05）. The difference of fracture detection quantity with SSD and DR was not statistically significant（ all P 〉0. 05）. The findings in classifying fracture with axial images, MPR, SSD and VR were obiviously better than that with DR. Conclusions Scanning of 16-SCT, MPR,SSD and VR techniques are important for the diagnosis and treatment of bone and joint fracture.