不同影像学方法对肱骨近端移位骨折分型的价值

The value of different imaging methods on classification in displaced proximal humeral fractures

目的 探讨普通X线片、二维CT、螺旋CT三维重建对肱骨近端移位骨折分型的价值。方法 搜集经手术治疗的肱骨近端移位骨折 4 6例 ,使用 3组不同的影像学方法 ,A组 :普通X线片4 6例 ,B组 :普通X线片结合二维CT横切面图像 18例 ;C组 :螺旋CT表面阴影成像 (SSD)、多平面重建术 (MPR)和原始二维横切面图像 10例。根据Neer分型法对骨折进行分型 ,比较不同的影像学方法对肱骨近端骨折分型的正确例数 ,并评价螺旋CT三维重建在肱骨近端骨折治疗中的作用。结果 A组 4 6例肱骨近端移位骨折中 ,Neer 2部分骨折 2 6例 ,Neer 3部分骨折 13例 ,Neer 4部分骨折 7例 ,普通X线片对Neer 2部分骨折正确分型为 2 2例 ,对Neer 3、4部分骨折正确分型为 8例 ,两者比较 ,差异有显著性意义 (P <0 0 5 )。B组 18例肱骨近端移位骨折中 ,Neer 2部分骨折 3例 ,Neer3部分骨折 9例 ,Neer 4部分骨折 6例 ,普通X线片结合二维CT图像对Neer 3、4部分骨折正确分型为 7例。C组 10例肱骨近端骨折中 ,Neer 2部分骨折 1例 ,Neer 3部分骨折 5例 ,Neer 4部分骨折 4例 ,螺旋CTSSD、MPR结合二维CT横切面图像对Neer 3、4部分骨折正确分型为 8例。就Neer 3、4部分骨折正确分型而言 ,3种不同的影像学方法对骨折正确分型结果的比较差异有显著性意义 (P

Objective To investigate the influence of common X-ray, two-dimensional computed tomography (2D-CT), spiral computed tomography (SCT), and three-dimensional (3-D) reconstruction on the classification in displaced proximal humeral fractures. Methods Three groups were divided on the basis of various imaging methods, including group A (common X-ray), group B (common X-ray and 2D-CT), and group C (3-D reconstruction of SCT and 2D-SCT). 46 cases of displaced proximal humeral fractures were classified with Neer system. The true rate of fracture classification by use of three methods was compared with each other, and clinical significance of SCT and 3-D reconstruction was evaluated.Results Based on operation, 46 cases of displaced proximal humeral fractures in group A included 26 cases of Neer two-part fractures, 13 cases of three-part fractures, and 7 cases of four-part fractures. The true cases of common X-ray were 22 in Neer two-part fractures and 8 in three and four-part fractures, there was significant difference between Neer two-part fractures and Neer three and four-part fractures (P<0.05); 18 cases of proximal humeral fractures in group B included 3 cases of Neer two-part fractures, 9 cases of three-part fractures, and 6 cases of four-part fractures. The true cases of common X-ray and 2D-CT were 7 in Neer three and four-part fractures. 10 cases of proximal humeral fractures in group C included 1 case of Neer two-part fracture, 5 cases of three-part fractures, and 4 cases of four-part fractures. The true cases of 3-D reconstruction, MPR of SCT, and 2D-SCT were 8 in Neer three and four-part fractures. With regard to the true cases of the classification in Neer three and four-part fractures, there was significant difference in three groups and between group A and group C (P<0.05). All SCT and 3-D reconstruction played an important role in the treatment of proximal humeral fractures. Conclusion Series of good quality X-ray examinations were the first imaging methods of choices in the diagnosis of proximal humeral fractures, and selective SCT and 3-D reconstruction can help to truly classify the fractures, select the best surgical approach, prepare surgical instruments, and explain the complexity of the fractures.