螺旋CT二维重建技术在三踝骨折治疗中的应用

Application of spiral CT scan and two-dimensional reconstruction in the 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作用。方法2005年1月至2006年1月浦南医院收治的22例三踝骨折患者,按Lauge-hansen分型,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。对患者术前和术后的X线片与螺旋CT二维重建的检查结果进行比较,对踝关节术后主观功能评分和客观功能评分与影像学评价之间的关系进行分析。结果术前X线片漏诊5例后踝骨折经螺旋CT扫描及二维重建技术确诊;随访时X线片显示关节面未完全复位1例,关节面完全复位的21例中,螺旋CT扫描及二维重建技术发现其中6例仍存在轻度关节面不平,关节面完全复位患者与关节面残留移位患者的主观功能评分存在显著性差异。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 explore the clinical significance of two-dimensional computed tomography reconstruction （2-D CT） in the treatment of cotton fractures. Methods Twenty-two cases of cotton fractures were involved from January.- 2005 to .lanuary 2006 in Punan Hospital. According to Lange-Hansen classification, 13 cases were Supnation-External rotation, stage Ⅳ; 6 cases Pronation-External rotation, stage Ⅳ： 3 cases Pronation-Abduction, stage m. Plain radiography and 2-D CT scan were performed before and after operation in all cases and their results were compared. The relationsbip of function assessment and the image evaluation was analyzed. Results Five cases of posterior malleolar fracture were not clear on plain radiography and were diagnosed preoperatively by 2-D CT scan. According to plain radiography , articular surface was incongruity in 1 case, and it was congruity in 21 cases, of which 6 cases were found slight incongruity by 2-D CT scan. Significant difference was found in the subjective evaluation between the congruity cases and incongruity cases. Conclusions Compared to plain radiography, 2-D CT can provide more accurate and more comprehensive information of the cotton fracture, so as to facilitate diagnosis, operation and assessment of the outcomes in the treatment of cotton fractures.