64排CT三维重建在累及关节面骨折治疗中的应用

Application of 64-slice CT three-dimensional reconstruction in the treatment of fractures involving the articular surface

目的探讨三维CT重建在累及关节面的复杂骨折治疗中的指导意义。方法包钢第三职工医院自2008年至今共收治累及关节面的复杂骨折40例（髋臼骨折12例，胫骨平台骨折18例，踝关节骨折10例），术前均行x线摄片并行CT扫描和三维CT重建，对关节面损伤程度进行评估并制定最佳治疗方案。结果12例髋臼骨折中9例行手术治疗，18例胫骨平台骨折中16例行手术治疗，10例踝关节骨折中7例行手术治疗。结论三维重建成像能立体地、直观地显示传统X线摄片所不能直接显示的关节面骨折，尤其在显示隐匿性骨折线方面明显优于CT平扫，对手术前的骨折分类、治疗方案制订以及手术入路选择有一定的指导意义，能为制定精细的手术方案提供可靠依据。

Objective To investigate the guiding significance of three-dimensional CT reconstruc- tion in treatment of complex fractures involving the articular surface. Methods From 2008 to the present, 40 patients with comlex fractures involving the articular surface（ acetabular fractures in 12 cases, tibial plat- eau fractures in 18 cases, ankle fractures in 10 cases） were admitted, preoperative X-ray, CT scanning and three-dimensional CT reconstruction of the articular surface were performed to assess the degree of injury and make best treatment options. Results Nine cases out of 12 cases of acetabular fracture underwent sur- gery treatment, 16 cases out of 18 cases of tibial plateau fractures underwent surgical treatment, 7 cases out of 10 cases of ankle fractures underwent surgical treatment. Conclusions Three-dimensional reconstruc- tion images can three-dimensionally, visually display the articular surface fractures which traditional X-ray can not directly show, especially is superior to CT scan in the show of occult fracture line, and has some guiding significance in classification of fracture before surgery, treatment options formulation and the choice of surgical approach. Therefore, it can provide reliable basis for making fine surgical method.