应用CT三维重建和关节镜监视下治疗胫骨平台骨折.docVIP

应用CT三维重建和关节镜监视下治疗胫骨平台骨折 　刘红光　陈述祥　丁林坚　赵崇达 [摘要] 目的 探讨应用CT三维重建和关节镜监视下治疗胫骨平台骨折中的价值。方法 收集22例胫骨平台骨折病例，术前常规进行X线摄片，按Schatzker分类法：Ⅰ型4例，Ⅱ型5例，Ⅲ型2例，Ⅳ型6例，V型3例，Ⅵ型2例。然后对每一例骨折在3D重建图像后再分型：前外象限4例，后外象限8例；前内象限4例，后内象限2例；涉及内和外象限4例。在关节镜监视下结合3D重建对骨折进行复位和内固定。结果 本组22例胫骨平台骨折3D重建图像分型与关节镜术中的判断一致。平台骨折需要植骨15例，松质骨螺钉固定4例，单侧支撑钢板内固定8例，双侧支撑钢板内固定4例，单侧支撑钢板加松质骨螺钉固定6例。随访3个月～2年，所有病人膝关节功能恢复优良。根据ＨＳＳ膝关节评分标准:优18例(81.8%)，良2例(9.1%)，可2例(9.1%)。结论　螺旋CT及3D重建补充了在胫骨平台三维空间上新的骨折分型，对手术入路、复位和内固定有指导意义。关节镜监视下有助于骨折复位，对骨折块的血运干扰少，骨折愈合快。 [关键词] 胫骨平台骨折　关节镜 内固定 Usage of Arthroscopic Technique and Spira1 CT and 3D Reconstructions in Treatment of the Tibial Plateau Fractures Hong-Guang Liu　Shu-xiang Chen Lin-jian Ding chong-da zhao Dept.of Orthopaedics,the 6th Affiliated Hospital of JiNan Medical College, 529000, Guangdong JiangMen china Abstract: Objective: To approach the application value of spira1 CT and 3D reconstruction and arthroscopic technique in treatment to the tibial plateau fractures. Method: 　22 cases with tibial plateau fractures were examined with plain radiographs and classified according to Schatzker’s classification.There were type Ⅰin 4 cases, type Ⅱin 5 cases, type Ⅲ in 2 cases ,type Ⅳ in 6 cases, type Ⅴ in 3 cases, typeⅥ in 2 cases. Then they were re-classified after spiral CT and 3D reconstruction images: anteroexternal quadrant in 4 cases, posterolateral quadrant in 8 cases, anteriomedialis quadrant in 4 cases, posterointernal quadrant in 2 cases, involving in internal and external quadrant in 4 cases. All tibial plateau fracture were reduced and fixed with arthroscopic-assisted and　3D reconstructions. Result: 22 cases of tibial plateau fractures re-classified by spiral CT and 3D reconstruction images were coincidence with that of arthroscopic-assisted opereation. 15 cases were needed bone graft.4 cases were fixed cancellous screw. 8 cases were fixed by unilateral buttress plate. 4 cases were fixed bilateral buttress plate. 6　cases were fixed by unilateral buttress plate and cance