计算机断层扫描三维重建在胫骨平台骨折诊治中的应用

Application of three-dimensional reconstruction of computed tomography in the diagnosis and treatment of tibial plateau fractures

目的探讨16排螺旋计算机断层扫描(CT)三维重建在胫骨平台骨折患者诊治中的应用价值。方法回顾性分析宁波市鄞州人民医院2014年1月至2016年10月收治的胫骨平台骨折患者58例的临床资料,患者均行锁定钢板内固定治疗,手术前后患者均行胫骨平台X线摄片和16排螺旋CT三维重建、多平面重建技术检查。比较两种检查方法对胫骨平台骨折检出率、术后7 d骨折坍塌面数值的差异,同时评价手术前后患者膝关节功能情况。结果CT三维重建检查对胫骨平台骨折检出率为100.0%,高于X线片检查的89.7%,两者差异有统计学意义(χ^2=4.39,P<0.05);CT三维重建检查测量术后7 d骨折坍塌面数值(3.42±0.86),显著高于X线片检查的(1.27±0.53),两者差异有统计学意义(t=16.21,P<0.05);手术后患者膝关节功能评分(56.4±4.8)分,显著高于手术前的(83.1±7.5)分,差异有统计学意义(t=22.84,P<0.05)。结论16排螺旋CT三维重建、多平面重建技术较X线片对胫骨平台骨折检出率高,尤其对胫骨平台隐匿性骨折,同时尚可更全面、直观、多方位显示骨折的类型及局部结构关系,值得临床选择。

Objective To investigate the application of 16-slice spiral computed tomography (CT) three-dimensional reconstruction in the diagnosis and treatment of tibial plateau fractures. Methods A retrospective analysis was performed on the clinical data of 58 patients with tibial plateau fractures from January 2014 to October 2016 in Ningbo Yinzhou People's Hospital.All patients underwent locking plate internal fixation.All patients underwent radiographs of the tibial plateau before and after surgery with 16-slice spiral CT three-dimensional reconstruction, multiplanar reconstruction technology inspection.The detection rates of tibial plateau fractures and the 7-day fracture collapse surface between the two examination methods were compared, and the knee joint function before and after surgery was evaluated. Results The detection rate of tibial plateau fractures by CT three-dimensional reconstruction examination was 100.0%, which was higher than that by the X-ray examination (89.7%), the difference was statistically significant(χ^2=4.39, P<0.05). The fracture collapse value of CT three-dimensional reconstruction examination after 7 days of operation was (3.42±0.86), which was significantly higher than that of X-ray examination (1.27±0.53)(t=16.21, P<0.05). The postoperative knee function score after surgery [(56.4±4.8)points] was significantly higher than that before surgery[(83.1±7.5)points](t=22.84, P<0.05). Conclusion The detection rate of 16-slice spiral CT three-dimensional reconstruction and multi-planar reconstruction is higher than X-ray film in tibial plateau fractures, especially for invisible fractures of the tibial plateau.It is more comprehensive and intuitive, multi-faceted display of fracture types and local structural relationships, which is worthy of clinical application.