CT扫描对胫骨平台骨折分型及治疗的影响分析

Analysis of influence of CT scan on classification and treatment of tibial plateau fracture

目的:结合临床案例探讨CT扫描对于胫骨平台骨折分型诊断和合理选择治疗方案的参考价值。方法:选取胫骨平台骨折患者56例,入院后对上述患者进行X线平片和CT扫描检查,比较两种影像学检查方法在Schatzker骨折分型上的差异,并据此调整相应的治疗方案。结果:X线平片诊断结果显示:Schatzker骨折分型Ⅴ型占14.3%(8/56),明确诊断率为87.5%(49/56);CT扫描结果显示:Schatzker骨折分型Ⅴ型占25.0%(14/56),明确诊断率为100.0%(56/56),CT扫描在明确诊断率方面明显高于X线平片,差异有统计学意义(P<0.05);在骨折分型分布上也与X线平片比较差异有统计学意义(P<0.05);在治疗方案方面,此前X线平片诊断为Ⅰ型后经CT扫描诊断为Ⅴ型的2例患者采取空心钉加压结合外侧钢板固定的方案治疗,此前X线平片诊断为Ⅱ型后经CT扫描诊断为Ⅴ型的2例患者采取内外踝双钢板固定方案,剩余2例此前X线平片诊断为Ⅰ型后经CT扫描诊断为V型,但骨折情况并不严重的患者则接受保守治疗。结论:CT扫描对于胫骨平台骨折的Schatzker分型的诊断准确性更高,以CT扫描结果作为参考调整治疗方案,可使临床治疗的合理性和安全性均有良好保障。

Objective: To investigate reference value of CT scan for diagnosis of tibial plateau fracture classification and reasonable selection of treatment plan by combining the clinical cases. Methods: A total of 56 patients with tibial plateau fractures were selected. X-ray and CT scans were performed on the patients. The differences between the two imaging methods in Schatzker fracture classification were compared, and accordingly, the treatment plan was adjusted. Results: X-ray plain film diagnosis showed that: among the 56 patients with tibial plateau factures, Schatzker fracture type Ⅴ accounted for 14.3%(8/56), and the diagnostic rate was 87.5%(49/56). CT scan showed Schatzker fracture type Ⅴ accounted for 25.0%(14/56), and the diagnostic rate was 100.0%(56/56). The definite diagnosis rate of CT scan was significantly higher than that of X-ray plain film, and the difference was statistically significant(P<0.05). Also, there was the statistical difference in the distribution of fracture classification between CT scan and X-ray film(P<0.05). In the aspect of treatment, 2 cases, firstly diagnosed as type Ⅰ by X-ray plain film and then diagnosed as Ⅴ type by CT scan, were treated with cannulated compression screw combined with lateral plate fixation;two patients, firstly diagnosed as type Ⅱ by X-ray plain film and then diagnosed as Ⅴ type by CT scan, were given the medical and lateral malleoles double plate fixation;the remaining 2 cases were diagnosed as type Ⅰ by X-ray plain film and type Ⅴ by CT scan, but the fracture was not severe, therefore, they received the conservative treatment. Conclusions: CT scan is more accurate for the Schatzker classification of tibial plateau fractures. The CT scan results can be used as a reference to adjust the treatment plan, which can ensure the rationality and safety of clinical treatment.