三维重建技术对复杂性胫骨平台骨折的诊断价值探究
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摘要
目的比较常规X线片检查、三维CT重建与MRI诊断复杂性胫骨平台骨折的临床效果。方法选取2012年1月~2016年12月瑞安市人民医院收治的复杂性胫骨平台骨折患者70例,均给予常规X线片检查,同时给予三维CT重建以及MRI检查,比较三种检查方法下患者胫骨平台显示满意度评分及诊断出的关节面塌陷、其余软性结构损伤的情况,同时分析三种检查的诊断符合率以及分型正确率情况。结果三维CT重建相比于X线片、MRI诊断关节面塌陷率较高,差异有统计学意义(P<0.05)。MRI相比于X线片、三维CT重建诊断其余软性结构损伤率较高,三维CT重建相比于X线片诊断其余软性结构损伤率较高,差异有统计学意义(P<0.05)。与X线片检查和MRI比较,三维CT重建诊断符合率高,且分型正确率也明显高于其他两组检查方法,差异有统计学意义(P<0.05)。结论三维重建CT重建则可直观而立体的显示胫骨骨折形态,对于诊断复杂性胫骨平台骨折,以及帮助发现膝关节及关节周围的隐匿性损伤,提高诊断的准确性,具有重要的临床作用。
Objective To compare X-ray, three-dimensional CT reconstruction and MRI in the diagnosis of complex tibial plateau fractures. Methods From January 2012 to December 2016, in People′ s Hospital of Ruian City, 70 patients with complex tibial plateau fracturesours were select, all the patients were given the conventional X-ray examination, three-dimensional CT reconstruction and MRI, of diagnosis of joint damage of the surface subsidence and rest of the soft structure, diagnostic coincidence rate and classification accuracy were compared. Results Compared with X-ray and MRI, three-dimensional CT reconstruction had a higher diagnosis rate of articular surface subsidence, the differences were statistically significant(P < 0.05). Compared with X ray film and three-dimensional CT reconstruction, MRI had a higher diagnosis rate of the rest of the soft structure damage, the differences were statistically significant(P <0.05). Compared with X-ray and MRI, three-dimensional CT reconstruction had higher diagnosis accordance rate and classification accuracy rate, the differences were statistically significant(P < 0.05). Conclusion Three-dimensional CT reconstruction can be intuitive and stereo display tibial fracture morphology, for the diagnosis of complex fractures of tibial plateau, helping found around the knee joint and joint of occult injury, improving the accuracy of diagnosis, it has important clinical effect.
Objective To compare X-ray, three-dimensional CT reconstruction and MRI in the diagnosis of complex tibial plateau fractures. Methods From January 2012 to December 2016, in People′ s Hospital of Ruian City, 70 patients with complex tibial plateau fracturesours were select, all the patients were given the conventional X-ray examination, three-dimensional CT reconstruction and MRI, of diagnosis of joint damage of the surface subsidence and rest of the soft structure, diagnostic coincidence rate and classification accuracy were compared. Results Compared with X-ray and MRI, three-dimensional CT reconstruction had a higher diagnosis rate of articular surface subsidence, the differences were statistically significant(P < 0.05). Compared with X ray film and three-dimensional CT reconstruction, MRI had a higher diagnosis rate of the rest of the soft structure damage, the differences were statistically significant(P <0.05). Compared with X-ray and MRI, three-dimensional CT reconstruction had higher diagnosis accordance rate and classification accuracy rate, the differences were statistically significant(P < 0.05). Conclusion Three-dimensional CT reconstruction can be intuitive and stereo display tibial fracture morphology, for the diagnosis of complex fractures of tibial plateau, helping found around the knee joint and joint of occult injury, improving the accuracy of diagnosis, it has important clinical effect.
引文
[1]陈羽,宋烜,张海兵.三维重建及虚拟手术在复杂胫骨平台骨折治疗中的应用[J].中国组织工程研究,2013,17(39):6940-6945.
[2]徐红卫,吴卫国.多层螺旋CT导航定位测量复杂性胫骨平台骨折的置钉位置[J].中国组织工程研究,2016,20(48):7239-7244.
[3]丁燕萍,杨莹.64排螺旋CT三维重建在胫骨平台骨折修复中的价值[J].中国组织工程研究,2015,19(4):612-617.
[4]Mellema JJ,Doornberg JN,Molenaars RJ,et al.Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures[J].Injury,2016,47(4):944-949.
[5]Markhardt BK,Gross JM,Monu JU.Schatzker classification of tibial plateau fractures:use of CT and MR imaging improves assessment[J].Radiographics,2016,29(2):585.
[6]徐红卫.胫骨平台骨折重建过程中64层CT的定位导航方法[J].中国组织工程研究,2016,20(26):3923-3928.
[7]张毅杰,陈雁西,张坤,等.基于CT三维重建图像的胫骨平台形态学研究及其临床意义[J].中华创伤杂志,2017,33(1):63-68.
[8]Yang G,Zhai Q,Zhu Y,et al.The incidence of posterior tibial plateau fracture:an investigation of 525 fractures by using a CT-based classification system[J].Arch Orthop Trauma Surg,2013,133(7):929-934.
[9]高翔,李杭,郑强,等.胫骨后外侧平台骨折的CT形态学研究[J].中华骨科杂志,2014,34(7):709-716.
[10]孙广江,姚啸生,李洪久,等.X线平片与三维CT检查在胫骨平台骨折评估中的应用价值[J].CT理论与应用研究,2016,25(4):485-491.
[11]Yunqin XU,Qiang LI,Peihua SU,et al.MDCT and MRI for the diagnosis of complex fractures of the tibial plateau:a case control study[J].Exp Ther Med,2014,7(1):199-203.
[12]孙毅,耿磊,陈瑶,等.隐匿性胫骨平台骨折计算机断层扫描及磁共振成像诊断价值探讨[J].中华创伤骨科杂志,2016,18(10):880-884.
[13]尹虎,何举仁.三维CT重建在复杂性胫骨平台骨折治疗中应用的价值[J].现代中西医结合杂志,2014,23(25):2791-2792.
[14]Zeltser DW,Leopold SS.Classifications in brief:Schatzker classification of tibial plateau fractures[J].Clin Orthop Relat Res,2013,471(2):371-374.
[15]高冠奇,张克远.CT图像后处理重建膝关节三维模型:3D-CT评估前交叉韧带重建后的骨道差异[J].中国组织工程研究,2015,19(40):6397-6401.
[16]陈羽,宋烜,张海兵.三维重建及虚拟手术在复杂胫骨平台骨折治疗中的应用[J].中国组织工程研究,2013,17(39):6940-6945.
[17]刘峰,李士春,云才.胫骨平台线性几何参数在CT三维重建中的测量及其意义[J].中国临床解剖学杂志,2013,31(3):265-268.
[18]姚景江,张亚林,贺亚琼,等.MRI在评价胫骨平台SchatzkerⅣ型骨折伴有半月板及韧带损伤中的价值[J].实用放射学杂志,2013,29(11):1832-1835.
[19]Dodd A,Paolucci EO,Korley R.The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures:a case–control series[J].BMC,2015,16(1):1-6.
[20]谭国光,欧艳荘,何瑞成.X线与CT平扫联合三维重建检查在胫骨平台骨折诊断中的应用价值比较[J].中国当代医药,2017,24(12):110-112.
[21]方海中,李君权.128层螺旋CT三维重建检查胫骨平台骨折的临床价值分析[J].医学影像学杂志,2013,23(9):1506-1508.
[2]徐红卫,吴卫国.多层螺旋CT导航定位测量复杂性胫骨平台骨折的置钉位置[J].中国组织工程研究,2016,20(48):7239-7244.
[3]丁燕萍,杨莹.64排螺旋CT三维重建在胫骨平台骨折修复中的价值[J].中国组织工程研究,2015,19(4):612-617.
[4]Mellema JJ,Doornberg JN,Molenaars RJ,et al.Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures[J].Injury,2016,47(4):944-949.
[5]Markhardt BK,Gross JM,Monu JU.Schatzker classification of tibial plateau fractures:use of CT and MR imaging improves assessment[J].Radiographics,2016,29(2):585.
[6]徐红卫.胫骨平台骨折重建过程中64层CT的定位导航方法[J].中国组织工程研究,2016,20(26):3923-3928.
[7]张毅杰,陈雁西,张坤,等.基于CT三维重建图像的胫骨平台形态学研究及其临床意义[J].中华创伤杂志,2017,33(1):63-68.
[8]Yang G,Zhai Q,Zhu Y,et al.The incidence of posterior tibial plateau fracture:an investigation of 525 fractures by using a CT-based classification system[J].Arch Orthop Trauma Surg,2013,133(7):929-934.
[9]高翔,李杭,郑强,等.胫骨后外侧平台骨折的CT形态学研究[J].中华骨科杂志,2014,34(7):709-716.
[10]孙广江,姚啸生,李洪久,等.X线平片与三维CT检查在胫骨平台骨折评估中的应用价值[J].CT理论与应用研究,2016,25(4):485-491.
[11]Yunqin XU,Qiang LI,Peihua SU,et al.MDCT and MRI for the diagnosis of complex fractures of the tibial plateau:a case control study[J].Exp Ther Med,2014,7(1):199-203.
[12]孙毅,耿磊,陈瑶,等.隐匿性胫骨平台骨折计算机断层扫描及磁共振成像诊断价值探讨[J].中华创伤骨科杂志,2016,18(10):880-884.
[13]尹虎,何举仁.三维CT重建在复杂性胫骨平台骨折治疗中应用的价值[J].现代中西医结合杂志,2014,23(25):2791-2792.
[14]Zeltser DW,Leopold SS.Classifications in brief:Schatzker classification of tibial plateau fractures[J].Clin Orthop Relat Res,2013,471(2):371-374.
[15]高冠奇,张克远.CT图像后处理重建膝关节三维模型:3D-CT评估前交叉韧带重建后的骨道差异[J].中国组织工程研究,2015,19(40):6397-6401.
[16]陈羽,宋烜,张海兵.三维重建及虚拟手术在复杂胫骨平台骨折治疗中的应用[J].中国组织工程研究,2013,17(39):6940-6945.
[17]刘峰,李士春,云才.胫骨平台线性几何参数在CT三维重建中的测量及其意义[J].中国临床解剖学杂志,2013,31(3):265-268.
[18]姚景江,张亚林,贺亚琼,等.MRI在评价胫骨平台SchatzkerⅣ型骨折伴有半月板及韧带损伤中的价值[J].实用放射学杂志,2013,29(11):1832-1835.
[19]Dodd A,Paolucci EO,Korley R.The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures:a case–control series[J].BMC,2015,16(1):1-6.
[20]谭国光,欧艳荘,何瑞成.X线与CT平扫联合三维重建检查在胫骨平台骨折诊断中的应用价值比较[J].中国当代医药,2017,24(12):110-112.
[21]方海中,李君权.128层螺旋CT三维重建检查胫骨平台骨折的临床价值分析[J].医学影像学杂志,2013,23(9):1506-1508.