三维成像辅助支持钢板置入内固定治疗胫骨平台骨折

Support plate for the treatment of tibial plateau fractures assisted with three-dimensional imaging

背景:复杂的关节内骨折二维成像不能准确反应损伤特点,依靠三维成像从三维空间清楚准确地观察骨折移位情况,从而能有效指导成功实施骨折内固定。目的:观察三维C臂术中三维成像辅助支持钢板内固定治疗胫骨平台骨折的临床疗效。方法:23例胫骨平台骨折患者实施了骨折切开复位支持钢板内固定术,术中三维C臂X光机扫描三维成像监视骨折复位及钢板螺钉位置。观察骨折复位、螺钉位置、切口愈合情况及有无并发症发生。膝关节功能评定采用Rasmussen评分标准。结果与结论:胫骨平台骨折一次性解剖复位17例,再次复位6例;螺钉位置良好11例,再次调整螺钉位置12例。18例随访3个月,膝关节功能恢复参照Rasmussen评分,优9例,良8例,可1例,优良率94%。提示胫骨平台骨折术中三维成像监视能实时细微地从冠状面矢状面横断面3个断层切面及立体三维重建了解骨折复位及内固定情况,有效提高了骨折解剖复位和内固定位置正确性,为膝关节功能恢复提供了良好的基础条件。

BACKGROUND：Two-dimensional imaging of complex intra-articular fracture can not accurately reflect the injury characteristics,but three-dimensional imaging can observe displacement fracture from three-dimensional space clearly and accurately,and thereby it can effectively guide surgery implementation of the surgeon.OBJECTIVE：To investigate the clinical efficacy of support plate for the treatment of tibial plateau fractures assisted with intra-operative three-dimensional imaging.METHODS：From April 2009 to May 2010,23 patients with tibial plateau fracture underwent open reduction and support plate fixation with intra-operative three-dimensional C-arm X-ray machine scanning to monitor fracture reduction and plate screw position as well as wound healing and complications.Rasmussen scale was used for evaluation of knee joint function.RESULTS AND CONCLUSION：There were 17 cases in anatomic reduction one-timely,6 cases in anatomic reduction secondly.There were 11 cases in satisfactory screw position,12 cases in screw position adjusted.A mean follow-up of 6.2 months was performed in 18 cases.The knee function recovery according to Rasmussen scores：excellent in 9 cases,good in 8 cases,moderate in 1 case.The excellent rate was 94.4%.The results indicated that intra-operative three-dimensional imaging can monitor fracture reduction and internal fixation conditions real-timely and finely from coronal plane,sagittal plane,cross section,and three-dimensional reconstruction,and effectively improve the anatomic reduction and internal fixation location accuracy,and provides a good foundation condition for the knee function recovery.