多层螺旋CT对胫骨平台骨折分型及治疗临床价值.docVIP

多层螺旋CT对胫骨平台骨折分型及治疗临床价值 　【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 multislice spiral Xray computed tomography(MSCT) volume rendering technique(VRT) and multiplanar reconstruction(MPR) in classification and treatment of tibial plateau fracture (TPF).[Method]From August 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); Schatzker’s classification; Xray c