多排螺旋CT三维重建技术在跟骨骨折中的应用价值探讨

The Application of Multiple Detector Spiral CT Reconstruction in the Calcaneal Fracture

目的:探讨多排螺旋CT(MSCT)三维重建在跟骨骨折中的应用价值。方法:对44名患者47例急性跟骨骨折的病人分别进行跟骨侧位、轴位X线摄片及MSCT扫描与后期容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)等后处理,观察并统计不同检查手段对骨折线的显示情况,并对累及跟距关节面的跟骨骨折进行Sanders分型。结果:跟骨骨折47例,MPR和VR显示16例单纯跟骨结节骨折,31例复杂性骨折;累及跟距关节面复杂骨折24例,累及跟骰关节面复杂骨折7例。按Sanders分型分为Ⅰ型6例,Ⅱ型27例,Ⅲ型9例,Ⅳ型5例。单纯X线片显示19例单纯跟骨结节骨折,28例粉碎性骨折;X线对于跟骨是否粉碎性骨折诊断的敏感性、准确性分别为90.32%及93.62%,与MSCT三维重建显示结果有差异性。结论:在跟骨骨折的多项影像学检查方法中,MSCT结合后期工作站三维重建技术能为跟骨骨折,尤其是粉碎性骨折患者的治疗方案提供准确、可靠的信息参考。

Objective ：To study the value of multiple detector computed tomo-graphy（MDCT） and three-dimensional reconstruction in the application of calcaneal fracture .Methods：47 calcaneal fractures in 44 patients with acute calcaneal fractures underwent multidetector CT .The post-processing techniques included multiplanar reformation （MPR） ,maximum intensity projection（MIP） and volume rendering（VR） .The bone and the surrounding soft tissue were reviewed . Results：47 calcaneal fractures including 3 bilateral fractures were diagnosed by X-ray ,MSCT ,VR ,MPR and MIP images ,16 of them were single and 31 were complicated fractures .24 posterior articular surfaces and 7 cuboid articular surfaces involved in the complicated fractures .According to Sanders criterion the fractures of calcaneal involving the posterior articular surface included type Ⅰ in 6 ,type Ⅱ in 27 ,type Ⅲ in 9 and type Ⅳ in 5 .While the sensitivity and accuracy of X-ray were only 90 .32% and 93 .62% .Conclusion：Preoperative MDCT scan with thee-dimensional reconstruction can exactly display the calcaneal fracture and classification ,and can accurately evaluate fracture shift condition and the tendonsthat is for surgical plan .