双源双能量CT扫描在锁骨远端骨折中的应用研究

Application of dual-energy CT scan in distal clavicle fractures

目的采用双源双能量CT(dual-energy CT,DECT)扫描,探讨其在合并韧带损伤的锁骨远端骨折中的应用价值。方法2019年1月至2021年6月,10例锁骨远端骨折患者纳入研究,其中男6例、女4例。平均年龄39.8岁,年龄范围15~67岁。利用DECT技术重建健侧及骨折端锁骨远端下表面斜方韧带及锥状韧带。锁骨远端骨折的类型和数量如下:Neer-craig 5型10例(骨折组),以健侧自身对照重建10例(对照组)。所有DECT韧带特定颜色映射图像均由1名放射科医生和1名骨科医师独立分析。每个重建韧带分为近端、中间和远端三部分,并使用三点量表分别评分(0=不存在"双能量染色";1=部分"双能量染色";2=完全"双能量染色")。结果重建韧带的总可视化得分平均值为5分或更多,满分6分。骨折组:斜方韧带(5.0±0.1)分,锥状韧带(5.2±0.1)分;对照组:斜方韧带(5.3±0.2)分,锥状韧带(5.7±0.2)分,对斜方韧带及锥状韧带的观察具有高度一致性(范围0.72~0.94)。结论DECT成像技术可以成为定性显示锁骨远端骨折斜方韧带及锥状韧带完整性,为指导临床分型及治疗提供重要参考。

Background Clavicle fracture has the highest incidence among shoulder fractures,accounting for about 2.6%-5.0%of total body fractures.Allman divided clavicle fractures into external 1/3,middle and internal 1/3 fractures according to the clavicle length,and distal fractures account for 21%-28%of all clavicle fractures.Distal clavicle fractures are prone to local instability due to many ligament structures,and there are still many controversies in diagnosis and treatment at present.Although MRI is the most commonly used method to diagnose soft tissue injury,there are still limitations in diagnosing acute fracture.Dual-energy CT(DECT)can reconstruct soft tissue characteristics of joint support structures such as ligaments by using collagen decomposition algorithms of three materials.Currently,tendon and ligament reconstruction in the ankle,wrist,hand,foot,and knee regions has been reported in the literatures.However,DECT has not been reported for ligament reconstruction in distal clavicle fractures.Objective To explore the value of dual-source CT dual-energy scan in distal clavicle fractures combined with ligament injuries.Methods From January 2019 to June 2021,10 patients(6 males and 4 females)with distal clavicle fractures were enrolled in the study,and the ages ranged from 15 to 67 years with an average age of 39.8 years.The DECT imaging technology was used to reconstruct the trapezoidal ligaments and conoid ligaments on the lateral clavicle of both sides.According to the Neer-Craig classification,all patients were type V,and the affected sides were reconstructed by comparing with the healthy sides.A radiologist and an orthopedist independently analyzed all DECT ligament-specific color mapping images.Each reconstructed ligament was divided into proximal,middle,and distal parts and scored respectively using a three-point scale(0=no"dual-energy staining",1=partial"dual-energy staining",and 2=complete"dual-energy staining").Results The average total visualization score of the reconstructed ligament was 5 points or more,with a maximum score of 6 points.In the fracture group,the score of trapezoid ligaments was(5.0±0.1)points and the score of the conoid ligaments was(5.2±0.1)points;in the control group,the score of trapezoid ligaments was(5.3±0.2)points,and the score of the conoid ligaments was(5.7±0.2)points.There was a high degree of consistency between the observations of the trapezium ligament and the conical ligament(0.72-0.94).Conclusion DECT imaging technology can be used to qualitatively display the integrity of the trapezoidal ligament and conoid ligament in distal clavicle fractures and provide an essential reference for guiding clinical classification and treatment.