基于CT三维重建测量的桡骨远端粉碎性关节内骨折尺背侧骨折块的影像解剖学研究

Imaging anatomy study of dorsal ulnar fragment in comminuted intra-articular fractures of the distal radius based on CT three-dimensional reconstruction and precise measurement

目的探讨基于CT三维重建与精确测量的桡骨远端粉碎性关节内骨折尺背侧骨折块(DUF)的影像解剖形态学特征及其临床意义。方法横断面研究。纳入2018年1月—2023年10月安徽医科大学第三附属医院关节骨科合并DUF的桡骨远端粉碎性骨折患者150例,其中男54例、女96例,年龄38~81(54±14)岁,AO23/C1型骨折43例、AO23/C2型69例、AO23/C3型38例。150例患者术前均行层厚为0.625 mm的高分辨率腕部CT扫描,基于CT扫描原始数据,利用Mimics软件建立桡骨远端骨折三维模型和统一测量坐标系,进而分离出DUF,分别在测量坐标系的X、Y、Z轴上测量DUF最大长度、宽度和高度,并测量矢状面骨折线角度(θ),计算DUF的最大长度、宽度与桡骨远端横断面(即关节面)最大长度、宽度的比值(FLr、FWr,%)作为消除体型差异影响后的DUF长度、宽度的矫正值,对比以上各指标在不同性别及不同骨折分型患者间的差异。结果150例患者DUF的最大长度为(14.1±3.5)mm、宽度为(12.0±2.1)mm、高度为(15.7±1.0)mm,θ为15.6°±1.8°,FLr为33.4%±4.4%,FWr为27.0%±3.1%。男性患者DUF的最大长度为(15.3±3.1)mm,大于女性患者的(13.4±3.5)mm,差异有统计学意义(t=-3.27,P=0.001),男、女性FLr值分别为33.5%±4.8%、33.3%±4.1%,差异无统计学意义(t=-0.27,P=0.791)。此外,DUF的宽度和高度、θ、FWr不同性别间比较,差异均无统计学意义(P值均>0.05)。AO23/C1型患者DUF的长度及FLr[(17.2±3.0)mm,36.0%±4.4%]大于AO23/C2型[(11.2±2.1)mm,31.3%±4.6%]和AO23/C3型[(13.9±2.7)mm,32.8%±3.4%],差异均有统计学意义(P值均<0.05),AO23C1型、C2型、C3型间DUF的宽度、高度,以及θ、FWr等形态学参数测量值比较,差异均无统计学意义(P值均>0.05)。结论不同类型的桡骨远端粉碎性关节内骨折中,DUF在矢状面上都表现出骨折角度相对垂直的不稳定模式,消除患者性别间体型差异后,不同性别患者的DUF形态差异并不明显,但C1型DUF的长度及其在桡骨远端横断面长度的占比明显大于C2型和C3型。以上研究成果提示DUF在手术复位中的重要性以及根据术前DUF精确三维形态数据进行个体化治疗的必要性。

Objective This study aimed to investigate the imaging anatomic morphological characteristics and clinical significance of dorsal ulnar fragment(DUF)in comminuted intra-articular fractures of distal radius on the basis of CT three-dimensional(3D)reconstruction and accurate measurement.Methods This cross-sectional investigation was conducted from January 2018 to October 2023,at the Third Affiliated Hospital of Anhui Medical University.It involved 150 patients with comminuted distal radius fractures accompanied by DUF,including 54 males and 96 females aged 38−81(54±14)years.The patients were categorized in accordance with fracture classification as follows:43 patients with AO23/C1 type,69 patients with C2 type,and 38 patients with C3 type.All patients underwent preoperative high-resolution wrist CT scans with a slice thickness of 0.625 mm.By using Mimics software,a 3D model of the distal radius fracture and a standardized measurement coordinate system were established on the basis of the original CT scan data.The 3D model of DUF was isolated,and its dimensions,including the maximum length,width,and height of DUF and the sagittal plane fracture line angle(θ),were measured on the X,Y,and Z axes of the standardized measurement coordinate system,respectively.The ratio of DUF,which was the maximum length/width to the maximum length/width of the distal radius cross-section(i.e.,the articular surface,FLr,FWr,%)was calculated as a corrected value for DUF dimensions after eliminating the influence of body type differences.Comparative analysis were conducted among different genders and fracture types on the basis of these parameters.Results The DUF length was(14.1±3.5)mm,the DUF width was(12.0±2.1)mm,the DUF height was(15.7±1.0)mm,theθwas 15.6°±1.8°,the FLr was 33.4%±4.4%,and the FWr was 27.0%±3.1%.The length of DUF in male patients[(15.3±3.1)mm]exceeded that in female patients[(13.4±3.5)mm],with statistically significant differences(t=−3.27,P=0.001).However,the FLr values for males(33.5%±4.8%)and females(33.3%±4.1%)showed no statistically significant difference(t=−0.27,P=0.791).There were no significant differences in the width and height of DUF,θ,and FWr between the males and the females(all P values>0.05).The DUF length and FLr in patients with AO23/C1 type([17.2±3.0]mm,36.0%±4.4%)were notably greater than those in patients with C2 type([11.2±2.1]mm,31.3%±4.6%)and C3 type([13.9±2.7]mm,32.8%±3.4%),with statistically significant differences(all P values<0.05).There was no significant difference in width,height of DUF,θ,and FWr in AO23/C1 type,AO23/C2 type and AO23/C3 type(all P values>0.05).Conclusion Within various comminuted distal radius fractures,DUF exhibited an unstable pattern characterized by a relatively perpendicular fracture angle on the dorsal aspect.After eliminating the body size differences between male and female patients,the morphological differences in DUF between different genders are not prominent.Notably,the length of DUF and its proportion in the distal radius cross-section were significantly larger in C1 fractures than those in C2 and C3 fractures.The above research findings indicate the significance of DUF in surgical reduction and underscore the necessity of individualized treatment based on precise preoperative 3D DUF.