多层螺旋CT对胫骨平台骨折分型及治疗的临床价值_临床医学论文.docVIP

多层螺旋CT对胫骨平台骨折分型及治疗的临床价值_临床医学论文 多层螺旋CT对胫骨平台骨折分型及治疗的临床价值_临床医学论文 【摘要】 [目的]探讨多层螺旋CT(MSCT)容积重组技术(VRT)和多平面重建(MPR)在胫骨平台骨折(TPF)分型及治疗中的临床应用价值。[方法]2005年8月-2009年2月对45例49侧TPF患者的病例资料进行回顾性分析。其中男32例，女13例;年龄20～65岁(平均46岁)。4例为双侧TPF。所有患者均行X线检查和64层螺旋CT扫描仪扫描。在轴位CT扫描后行VRT和MPR成像。按照Schatzker分型标准，应用X线片与64层螺旋CT扫描(包括VRT、MPR成像)分别进行分型和制定相应的治疗方案。[结果]参考VRT、MPR成像后，更改X线分型13侧(13/49)、更改治疗方案8侧(8/49)、发现胫骨髁间嵴骨折15侧(漏诊率46.9%)和腓骨近端骨折6例(漏诊率28.6%)。[结论]MSCT(VRT+MPR)可以清晰显示TPF塌陷的范围和程度、细节及隐匿骨折，有助于骨折的正确分型、降低漏诊率和选择合理的治疗方案，是X线片和轴位CT扫描有效的补充手段，具有较高临床应用价值。 【关键词】 胫骨平台骨折; Schatzker分型; 计算机体层成像 　　Abstract：[Objective]To observe clinical value of multist 2005 to February 2009,49 fratures in 45 patients with TPF were treated.Their clinical data were studied retrospectively.There were 32 males and 13 females.The patients were aged from 2065 years(mean 46 years).Four patients suffered bilateral TPF.All patients were examined with standard Xrays and 64slice spiral CT scanner.Axial CT scans were processed with VRT and MPR.Their Xray plain films and 64slice spiral CT scans (including VRT and MPR) were performed to determine their fracture types and protocol.[Result]According to the VRT and MPR findings,13 fractures(13/49) classified by Xray plain film were corrected,protocols were changed for 9 fractures (9/49),and 15 fractures(46.9%) of intercondylar eminence of the tibia and 6 fractures(28.6%) of proximal fibula were underdiagnozed.[Conclusion]MSCT (VRT+MPR) can clearly show the area and degree of tibial plateau collapse,the details of TPF and the delitescence fracture,help to determine TPF types,decrease the underdiagnosis rate and choose a rational protocol.The use of combined VRT and MPR is a supplementary means for Xray plain film and axial CT scanning,which has great clinical value. 　　Key words：tibial plateau fracture(TPF); Schatzkers classification; X 　　作者简介：张海波(1966-)，男，河南开封市人，副主任医师，研究方向：脊柱外科、创伤骨科，(电话)0378-5672507，(电子信箱)Zhb.2008.2008@163.com 胫骨平台骨折(Tibial plateau fracture,TPF)属临床常见的关节内骨折损伤类型，治疗不当易造成创伤性关节炎等并发症的发生，