CT矢状位图像在评估肘关节僵硬中异常骨性结构的作用

Role of CT sagittal images in evaluation of abnormal osseous structure causes of elbow stiffness

目的探讨CT矢状位图像在评估肘关节僵硬中异常骨性结构的价值。方法自2010-12—2013-12诊治30例肘关节僵硬患者,X线片提示肘关节周围存在异常骨性结构,创伤性肘关节僵硬18例,退变性肘关节僵硬12例;术前测量肘关节的实际屈伸活动度,并给予CT三维重建,选择能够全面反映异常骨性结构的CT矢状位图像,测量肘关节的活动度。对矢状位图像测量的肘关节活动度与临床实际测量的肘关节活动度进行统计学分析。结果创伤性肘关节僵硬组矢状位图像测量的活动度为(50.7±14.8)°,实际屈伸活动度为(31.2±12.7)°,差异有统计学意义(P<0.05)。在退变性肘关节僵硬组矢状位图像测量活动度为(42.2±11.2)°,实际测量屈伸活动度(40.6±10.6)°,差异无统计学意义(P>0.05)。结论CT矢状位图像在评估肘关节周围的异常骨性结构起重要作用,在创伤性肘关节僵硬中软组织挛缩可能要比异常骨性阻挡更影响肘关节的活动;而在退变性肘关节僵硬中主要还是与异常的骨性阻挡有关。

Objective To investigate the role of CT sagittal images in evaluation of the abnormal osseous structure causes of elbow stiffness. Methods From December 2010 to December 2013 in our hospital 30 patients with elbow stiffness were treated. The inclusion criteria： X-rays showed clearly the presence of abnormal osseous structures around the elbow. Eighteen cases had traumatic elbow stiffness, 12 cases degenerative elbow stiffness. The actual range of motion of the elbows was measured. Three-dimensional CT reconstruction was made, one or two sagittal CT images were selected that could fully reflect the abnormal osseous structures, and the activity of the elbow in the sagittal image was measured. All data were statistically analyzed. Results In group of traumatic stiff elbow, the clinical actual activity range of motion was （31.2±12.7）°, the sagittal image was （50.7±14.8）°, there were significant differences （P 〈0.05）. In group of degenerative stiff elbow, the clinical actual activity was （40.6±10.6）°, sagittal image （42.2±11.2）°, there were no significant differences（P 〉0.05）. Conclusion Sagittal CT image plays an important role in assessing the abnormal osseous structures around the elbow. Soft-tissue abnormalities rather than osseous abnormalities may be responsible for restriction of motion in the traumatic elbow stiffness, while the abnormal osseous structures are the major factors in the degenerative elbow stiffness.