螺旋CT在肘关节周围复杂骨折诊断治疗中的应用

Spiral CT in diagnosis and treatment of complex fractures around the elbow

目的探讨螺旋CT在肘关节周围复杂骨折诊断治疗中的意义，以提高肘部骨折的诊疗水平。方法2005年1月至2007年5月，对32例有移位的肘关节周围骨折患者术前进行常规X线片、CT平扫及螺旋CT检查，明确骨折类型，然后制定手术方案和选择最佳的手术入路，术后随访并观察肘关节功能的康复情况。结果32例肘关节周围骨折中，X线片可明确骨折诊断及分型者17例；CT平扫可明确骨折诊断及分型者30例；螺旋CT可明确诊断及分型者32例。通过螺旋CT对患者肘关节周围骨折明确的分型诊断，针对不同骨折类型，采用个性化手术治疗。32例患者术后随访6～24个月（平均15个月），术后患肘关节的活动范围较术前好，届曲平均125°；伸直差值平均24．5°；旋前平均80°；前臂旋后平均75°。X线检查骨折愈合好，无骨化性肌炎，无一例发生伤口感染、术后关节不稳和明显疼痛等并发症。依据Mayo肘关节功能评定标准：优21例，良7例，可4例，优良率为87．5％。结论术前行螺旋CT能够在三维空间直观、清晰地显示出肘关节周围复杂骨折的全部细节，有助于确定骨折分型，有利于临床医生在术前选择适当、合理的治疗方案、手术入路和内固定方法，从而提高肘部复杂骨折的诊疗水平。

Objective To evaluate spiral CT in diagnosis and treatment of complex elbow fractures. Methods From January 2005 to May 2007, 32 cases of displaced elbow fracture were checked with X-ray, CT scanning and spiral CT to determine their fracture type, according to which the best surgical approach and appropriate treatment protocols were chosen. Their elbow functions were observed after operation. Results The fracture type was determined by X-ray examination in 17 cases, by CT scanning in 30 cases, but by spiral CT in all patients. Individualized treatments were adopted according to the specific fracture type diagnosed. Patients were followed up for 6 to 24 （mean, 15） months. After operation the range of motion of the elbow improved. Flexion averaged 125°, extension margin averaged 24.5°, pronation averaged 80°, and forearm supination averaged 75°. X-ray inspection indicated fracture healing, no myositis ossificans, no wound infection, no postoperative joint instability, no obvious pain or other complications. By Mayo elbow functional criteria, 21 patients scored excellent, 7 good, and 4 fair. Conclusion Spiral CT can clearly show three-dimensional details of a complex fracture of the elbow so that it helps surgeons determine fracture type and choose an appropriate treatment protocol on the basis of accurate knowledge of the complexity of the elbow fracture.