应用三维CT重建技术术前评估粉碎性跟骨骨折的临床研究

CLINICAL STUDY OF PREOPERATIVE EVALUATION OF COMMINUTED CALCANEAL FRACTURE WITH 3D CT RECONSTRUCTION

目的探讨应用三维CT重建技术术前评估粉碎性跟骨骨折的临床应用价值。方法回顾性分析我院70例(106足)粉碎性跟骨骨折患者的临床资料,所有患者术前均经X线检查、CT及三维重建检查,依据螺旋CT三维重建对70例(106足)粉碎性跟骨骨折进行分型,其中46例(72足)采取切开复位治疗,24例(34足)采取撬拨复位治疗,并分析术后疗效差异。结果 70例(106足)粉碎性跟骨骨折经螺旋CT三维重建分为8种骨折分型,ⅠA型6足,ⅠB型14足,ⅠC型16足,ⅡA型13足,ⅡB型16足,ⅡC型13足,ⅡD型13足,Ⅲ型15足。粉碎性跟骨骨折术后总优良率为67.92%。切开复位与撬拨复位治疗ⅠA、ⅠB、ⅡA型骨折术后优良率差异无统计学意义(P>0.05)。在ⅠC、ⅡB、ⅡC、ⅡD、Ⅲ型骨折中,切开复位治疗的优良率高于撬拨复位治疗的优良率,差异有统计学意义(P<0.05)。结论三维CT重建技术可较清楚地显示粉碎性跟骨骨折情况,对术前骨折分型及手术方案的选择有重要指导作用,ⅠC、ⅡB、ⅡC、ⅡD、Ⅲ型骨折应积极采取切开复位内固定治疗。

Objective To evaluate the clinical value of three dimensional CT reconstruction technique for the evaluation of comminuted calcaneal fracture before operation.Methods The clinical data of seventy cases(106 feet) of comminuted calcaneal fracture in Wuxi People′s Hospital were analyzed retrospectively.All the patients were examined by X-ray,CT and 3D reconstruction.According to spiral CT 3D reconstruction,70 cases(106 feet) comminuted calcaneal fractures were typed.46 cases(72 feet) were treated by open reduction,24 cases(34 feet) were treated by prying reduction,and the difference of postoperative efficacy was analyzed.Results 70 cases(106 feet) comminuted calcaneal fractures were classified into 8 types according to their spiral CT 3D reconstruction:type A 6 feet,type B 14 feet,type C 16 feet,type Ⅱ A 13 feet,type Ⅱ B 16 feet,type Ⅱ C 13 feet,type Ⅱ D 13 feet,type Ⅲ 15 feet.The total excellent rate of comminuted calcaneal fracture was 67.92%.There was no significant difference between open reduction and prying reduction for type Ⅰ A,I B,and Ⅱ A fractures(P>0.05).In patients with type Ⅰ C,Ⅱ B,Ⅱ C,Ⅱ D and Ⅲ fractures,the excellent and good rate of open reduction treatment was higher than that of prying reduction therapy(P<0.05).Conclusion The three-dimensional CT reconstruction technique can clearly display the fracture of the comminuted calcaneus,and has an important guiding role for the preoperative fracture classification and the choice of the operation scheme.Ⅰ C,Ⅱ B,Ⅱ C,Ⅱ D,and type Ⅲ fractures should be treated with open reduction and internal fixation.