术前CT扫描三维重建对胫骨平台骨折手术方式和内固定选择的评价

Three-dimensional Reconstruction of Preoperative CT Scan of Tibial Plateau Fracture Fixation Methods and the Evaluation of Options

目的探讨术前CT扫描三维重建对胫骨平台骨折手术方式和内固定选择的评价。方法选择我科2007年1月至2010年12月收治78例胫骨平台骨折患者,其中男43例,女35例,平均年龄43.5岁,术前均行膝关节正、侧位X线片及三维CT扫描检查。结果依据CT扫描三维重建图像参照Schatzker分型法对胫骨平台骨折分型,5例Ⅱ型骨折改为Ⅴ型;4例Ⅲ型骨折改为Ⅱ型,3例Ⅲ型骨折改为Ⅴ型,5例Ⅳ型骨折改为Ⅴ型。共有17例骨折更改分型,更改率为21.8%。其中9例更改手术入路和内固定方法,占78例骨折的11.5%。结论术前CT扫描三维重建能够准确的判断骨折的类型和程度,全面准确的展示胫骨平台骨折的类型、骨块易位的方向和平台塌陷的程度,有利于临床医师在术前对骨折的胫骨平台进行全面的观察,选择手术入路和内固定的种类、位置和方向,缩短手术时间,减少手术中出血和损伤,值得临床推广。

Objective To evaluate the preoperative CT scan three-dimensional reconstruction of the tibial plateau fracture fixation methods and choice of evaluation.Methods Our department in January 2007-2010 78 patients were treated in December tibial plateau fracture patients,43 patients were male and 35 female,mean age 43.5 years,underwent knee surgery prior to the positive and lateral X-ray films and three-dimensional CT scan.Results According to three-dimensional reconstruction of CT scan images with reference to Schatzker classification method,classification of tibial plateau fracture,5 cases changed toⅤ-Ⅱfractures;4 cases of typeⅡto typeⅢfractures,3 cases of typeⅢtoⅤ-type fracture,5 cases of fracture toⅤ-typeⅣ.A total of 17 cases of fracture type changes,change the rate of 21.8%.Which change the surgical approach in 9 cases and internal fixation,accounting for 11.5%of 78 cases of fracture.Conclusion Preoperative CT scan can accurately determine the three-dimensional reconstruction of fracture type and extent of,fully and accurately display the type of tibial plateau fractures,bone translocation direction and degree of collapse platform is conducive to clinicians in the preoperative fracture tibial plateau to conduct a comprehensive observation,select the surgical approach and internal fixation of type,location and direction,shorten the operation time,blood loss and reduce hand injuries,is worthy of promotion.