CT三维重建在骨盆骨折及盆腔脏器损伤手术治疗方案设计中的价值

The value of CT three-dimensional reconstruction in the design of operation treatment of pelvic fracture and pelvic organ injury

目的探讨螺旋CT三维重建在骨盆骨折及盆腔脏器损伤手术治疗方案设计中的价值。方法分析2007年1月至2013年12月行手术治疗的骨盆骨折及盆腔脏器损伤的患者CT三维重建影像资料,比较术前与术后影像资料及疗效。采用SPSS 17.0统计软件和χ2检验分析轴位CT及三维CT对骨盆骨折诊断的差异。结果149例骨盆骨折患者通过CT三维重建确诊髂骨骨折19例、骶尾骨骨折43例、耻骨上下支骨折30例及髋臼骨折57例;关节脱位21例、耻骨联合分离5例。轴位CT组与三维CT组间比较在髋臼骨折及骶尾骨骨折上,差异有统计学意义(P<0.05)。髂骨骨折、耻骨上下支骨折、关节脱位及耻骨联合分离无统计学意义。合并盆腔脏器损伤有17例,其中膀胱破裂8例、后尿道损伤5例,盆腔血肿4例。149例患者术后复位效果中解剖复位64例,满意75例,不满意14例。获得随访20 d至83个月。按Matta疗效标准评定,临床标准:优97例,良45例,可7例,优良率95%;X线标准:优95例,良45例,可9例,优良率94%。结论螺旋CT三维成像多平面重建(MPR)、容积重建(VR)及表面遮盖重建(SSD)以最直观、全面的骨盆骨折及盆腔脏器损伤图像肯定并明确螺旋CT对骨盆骨折的分型;对治疗方案、手术入路、内固定物的选择和制定详细的手术计划可提供正确指导,在骨盆骨折及盆腔脏器损伤术前、术后影像检查中有较高的价值。

Objective To explore the value of spiral CT 3D reconstruction in the operation treatment of pelvic fracture and the injury of pelvic organs. Methods Retrospective review the image data of spiral CT 3D reconstruc-tion of pelvic fracture and pelvic organ injury in January 2007 to December 2013 operation treatment, compare preop-erative imaging and postoperative data and curative effect. The detection rate between axial CT and 3D CT scan in di-agnosing pelvic fractures was compared by the chi-square test. Results One hundred and forty-nine cases of pelvic fracture have 19 cases of iliac fractures, 43 cases of sacrum and coccyx fractures, 30 cases of pubic upper and lower branches fractures and 57 cases of acetabular fractures. Twenty-one cases of joint dislocation, 5 cases of pubic symph-ysis separation. Acetabular fractures and sacral and coccyx fractures had statistical differences （ P〈0.05）. There was no statistical difference in iliac fractures and pubic upper and lower branches fractures and joint dislocation and pubic symphysis separation. Patients with pelvic organ injury in 17 cases, including 8 cases were bladder rupture, 5 cases were urethral injury, 4 cases were pelvic hematoma. The reduction effect of 149 cases with postoperative 64 cases were anatomical reduction, 75 cases were satisfactory, 14 cases were unsatisfactory. Patients were followed up from 20 days to 6 years and 11 months. According to the criteria of Matta assessment, clinical criteria： 97 cases were excel-lent, 45 cases were good, 7 cases were approved, with the excellent and good rate was 95%; X-ray standard： 95 cases were excellent, 45 cases were good, 9 cases were average with the excellent and good rate was 94%. Conclusion Spiral CT 3D reconstruction image of the pelvic fracture and pelvic organ damage must be the most direct, compre-hensive to certain and understand spiral CT in the typing of pelvic fracture and to provide correct guidance in treat-ment, operation approach, the choice of fixation and formulate detailed operation plan. There was high clinical value in the examining of pelvic fracture and pelvic organ injury before and after operation.