CT三维重建技术在桡骨远端骨折术后评价中的应用

Application of 3D reconstructed CT imaging technique to postoperative evaluation of distal radius fractures

目的:探讨CT三维重建技术在桡骨远端骨折术后评价中的应用价值。方法:2012年1月至2016年6月,收治桡骨远端骨折患者80例,男21例,女59例;年龄20~80岁,中位数55岁;左侧38例,右侧42例。均为闭合性骨折。骨折Melon分型,Ⅱ型21例、Ⅲ型23例、Ⅳ型19例、Ⅴ型17例。均由同一组医生行前臂远端掌桡侧入路切开复位、掌侧锁定钢板内固定治疗。术后第2天,拍摄腕关节正、侧位X线片,并行CT三维重建检查,对骨折复位情况及内固定位置进行评价,并对2种方法的评价结果进行比较。结果:本组80例患者术后骨折复位情况评价,X线片上骨折解剖复位67例、未达解剖复位13例,CT三维重建片上骨折解剖复位50例、未达解剖复位30例;2种方法评价结果总体比较,差异有统计学意义(χ~2=9.191,P=0.002);对MelonⅡ型患者的术后骨折复位情况进行评价,X线片上骨折解剖复位18例、未达解剖复位3例,CT三维重建片上骨折解剖复位12例、未达解剖复位9例,2种方法评价结果之间的差异有统计学意义(χ~2=4.200,P=0.040);但分别对MelonⅢ型、Ⅳ型、Ⅴ型患者的术后骨折复位情况进行评价,2种方法评价结果之间的差异均无统计学意义(χ~2=1.075,P=0.300;P=0.269;P=0.259)。术后内固定位置评价,X线片上内固定位置良好65例、内固定位置不佳15例,CT三维重建片上内固定位置良好52例、内固定位置不佳28例;2种方法评价结果总体比较,差异有统计学意义(χ~2=5.373,P=0.020);但分别对各骨折分型(MelonⅡ型、Ⅲ型、Ⅳ型、Ⅴ型)患者的术后内固定位置进行评价,2种方法评价结果之间的差异均无统计学意义(χ~2=3.079,P=0.079;χ~2=0.511,P=0.475;P=0.295;P=0.708)。骨折未达解剖复位者,多为粉碎的小骨块,无法有效固定;内固定位置不佳者,主要为螺钉外露、穿透关节面或进入关节腔。结论:CT三维重建技术用于桡骨远端骨折的术后评价,较X线检查更有利于发现骨折复位不良和内固定位置不佳。

Objective： To explore the applied value of 3D reconstructed CT imaging technique in postoperative evaluation of distal radius fractures. Methods： Eighty patients with closed fracture of distal radius were recruited from January 2012 to June 2016. The patients consisted of 21 males and 59 females,and ranged in age from 20 to 80 years（ Median = 55 yrs）. The fractures located in left radius for 38 patients and right radius for 42 patients. According to Melon classification of fracture,the fractures belonged to typesⅡ（ 21）,Ⅲ（ 23）,Ⅳ（ 19）andⅤ（ 17）. Open reduction and volar locking plate internal fixation through distal antebrachial volar-radial approach were performed on all patients by the same group of surgeons. The results of fracture reduction and internal fixation were evaluated by taking anteroposterior and lateral X-ray films and 3D reconstructed CT images of wrist joints at postoperative day 2,and the evaluation results were compared between the the 2 methods. Results： The fractures reached anatomical reduction in 67 patients and did not reach anatomical reduction in 13 patients according to X-ray evaluation results,while the fractures reached anatomical reduction in 50 patients and did not reach anatomical reduction in 30 patients according to 3D reconstructed CT images. There was statistical difference in the evaluation results between the 2methods in general（ χ^2= 9. 191,P = 0. 002）. The Melon typesⅡfractures reached anatomical reduction in 18 patients and did not reach anatomical reduction in 3 patients according to X-ray evaluation results,while the Melon typesⅡfractures reached anatomical reduction in 12 patients and did not reach anatomical reduction in 9 patients according to 3D reconstructed CT images. There was statistical difference in the evaluation results between the 2 methods（ χ^2= 4. 200,P = 0. 040）. However,there was no statistical difference in the evaluation results of postoperative reduction of Melon typesⅢ,ⅣandⅤfractures between the 2 methods（ χ^2= 1. 075,P = 0. 300; P = 0. 269; P = 0. 259）. Sixty-five patients obtained a good internal fixation of fracture and 15 patients obtained a poor internal fixation of fracture according to X-ray evaluation results,while 52 patients obtained a good internal fixation of fracture and 28 patients obtained a poor internal fixation of fracture according to 3D reconstructed CT images. There was statistical difference in the evaluation results between the 2 methods in general（ χ^2=5. 373,P = 0. 020）. However,there was no statistical difference in the evaluation results of postoperative internal fixation of Melon typesⅡ,Ⅲ,ⅣandⅤfractures between the 2 methods（ χ^2= 3. 079,P = 0. 079; χ^2= 0. 511,P = 0. 475; P = 0. 295; P = 0. 708）. The unsuccessful anatomical reduction of fractures were mostly caused by comminuted small bone block which couldn＇t be effectively fixed. The poor internal fixation presented mainly with exserted screws and screws that penetrated the articular surface or entered into the articular cavity. Conclusion：3D reconstructed CT imaging technique is more conducive to find poor fracture reduction and internal fixation than X-ray examination in postoperative evaluation of distal radius fractures.