螺旋CT二维重建技术在三踝骨折治疗中的应用

Application of two-dimensional CT reconstruction in treatment of cotton fractures

目的探讨螺旋CT扫描二维重建技术在三踝骨折治疗中的价值。方法按Lauge-hansen分型,22例三踝骨折患者中,13例为旋后-外旋Ⅳ度,6例为旋前-外旋Ⅳ度,3例为旋前-外展Ⅲ度。所有患者在术前和术后行X线摄片及螺旋CT二维重建检查,并在术后进行Philips踝关节客观功能评分和Olerud-Molander主观功能评分。结果术前X线片漏诊5例后踝骨折,经螺旋CT二维重建技术确诊。术后X线检查示,1例患者关节面未完全复位(骨折移位3 mm),21例患者关节面完全复位;但螺旋CT二维重建示,21例中6例仍残留关节面轻度移位。术后12个月,关节面完全复位的15例患者与关节面残留移位的6例患者的Phillips踝关节客观功能评分的差异无统计学意义(P=0.053);关节面完全复位者的Olerud-Molander主观功能评分显著高于关节面残留移位者(P=0.043)。结论螺旋CT二维重建技术能更全面、更准确地提供踝关节骨折的信息,有利于术前诊断、指导手术和疗效评估。

Objective To investigate the role of two-dimensional computed tomography reconstruction （2-D CT） in treatment of Cotton fractures. Methods Twenty-two patients with Cotton fractures were included in this study. According to Lange-Hansen classification, 13 cases had Supnation-External rotation, stage Ⅳ; 6 had Pronation-External rotation, stage Ⅳ; and 3 had Pronation-Abduction, stage Ⅲ. Plain radiography and 2-D CT scanning were performed before and after operation in all cases and their results were compared. Philips score system and Olerud-Molander subjective scoring were used after operation for function evaluation. Results 2-D CT scan confirmed the diagnosis of 5 cases with posterior malleolar fracture, which were missed by plain radiography. Plain radiography showed that after operation 1 patient had incongruity in articular surface （displacement〉3mm） and the rest had congruity. However, 2-D CT scan revealed that 6 of the 21 who showed congruity on plain radiography had slight incongruity. One year after operation, the Phillips scores （subjective part） were not significantly different between the congruity group（15 cases） and the incongruity group（6 cases, P=0.053）. The Olerud-Molander scores of the congruity group was much higher than that of the incongruity group （P = 0. 043 ）. Conclusion 2-D CT scanning can provide more accurate and more comprehensive information of the cotton fracture, which may contribute pre-operation diagnosis, operation and assessment of the outcomes of cotton fracture.