螺旋CT三维重建在跟骨骨折诊断中的应用研究
摘要
目的：通过螺旋CT重建图像来探讨跟骨骨折的特征及其在跟骨骨折诊断中的临床应用价值。
材料与方法：经CR或临床检查可疑或确诊有跟骨骨折的病人,应用LightSpeedPlus/i GE扫描机进行检查,其中对44例47侧跟骨关节内骨折行多平面及表面重建,对跟骨骨折进行分类,同时分析各关节面受累及骨折块数目显示等情况。
结果：跟骨结节位扫描是显示各关节受累总数最多的一种方法(95/101),冠状位重建是显示距下中(14/14)、后(47/47)关节面受累的较佳方法,而跟骰关节的骨折则在跖位(32/32)、结节位(32/32)扫描时得到较准确的显示,矢状位重建在显示骨折块数目及排列方面有一定的优势；表面三维重建则是观察跟骨骨折整体空间改变的一种方法；47侧关节内骨折中,除了3侧载距突骨块发生轻度移位,其它无一发生移位；11(11/47)侧关节内骨折者,后关节面的压缩及旋转移位的情况在冠状位上并没有被准确的反映出来；螺旋CT可较清晰的显示周围软组织特别是腓骨肌腱的损伤。
结论：螺旋CT重建在跟骨骨折诊断中具有很高的临床价值,对术前骨折的分型、手术入路的选择及估计预后有重要价值。
Objective To investigate the characteristics of calcaneal fractures with spiral CT multiplanar volume reconstruction (MPVR)、surface shaded display (SSD), and to determine the value of MPVR and SSD in the diagnosis of calcaneal fractures.
Materials and Methods Patients suspected or diagnosed with calcaneal fracture were imaged conventional scans with SCT, then 47 fractures diagnosed with intraarticular calcaneal fracture were farther postprocessed with the techniques of MPVR and SSD to classify the fractures and to show the condition of involvement of joints and the numbers of fragments and so on.
Results Tuberosity slice showed the most involvement of articular facets in all cases. Coronal slice was superior to showing the medial and postenrior facets while involvment of the calcaneo-cuboid facets were defined most clearly in axial and tuberosity slice. The number of fragments was determined most reliably on the basis of the sagital reconstructions.The SSD version offered the spatial allocation of the individual slices, and well evaluated preoperatively the degree of joint injury and depression. Little displacement (only three fractures) of sustentaculum tali occurred. The severity of articular incongruity and rotational displacement of the posterior facet fragments were not well appreciated in coronal CT images of 11 fractures. Soft tissue abnormalities such as peroneal tendon could be clearly detected.
Conclusion Spiral CT SSD and MPVR have important value in the diagnosis of calcanenl fracture, they play an important role in the preoperative classification of calcaneal fractures, and are useful for the selection of surgical approaches, and for the evaluation of prognosis.
材料与方法：经CR或临床检查可疑或确诊有跟骨骨折的病人,应用LightSpeedPlus/i GE扫描机进行检查,其中对44例47侧跟骨关节内骨折行多平面及表面重建,对跟骨骨折进行分类,同时分析各关节面受累及骨折块数目显示等情况。
结果：跟骨结节位扫描是显示各关节受累总数最多的一种方法(95/101),冠状位重建是显示距下中(14/14)、后(47/47)关节面受累的较佳方法,而跟骰关节的骨折则在跖位(32/32)、结节位(32/32)扫描时得到较准确的显示,矢状位重建在显示骨折块数目及排列方面有一定的优势；表面三维重建则是观察跟骨骨折整体空间改变的一种方法；47侧关节内骨折中,除了3侧载距突骨块发生轻度移位,其它无一发生移位；11(11/47)侧关节内骨折者,后关节面的压缩及旋转移位的情况在冠状位上并没有被准确的反映出来；螺旋CT可较清晰的显示周围软组织特别是腓骨肌腱的损伤。
结论：螺旋CT重建在跟骨骨折诊断中具有很高的临床价值,对术前骨折的分型、手术入路的选择及估计预后有重要价值。
Objective To investigate the characteristics of calcaneal fractures with spiral CT multiplanar volume reconstruction (MPVR)、surface shaded display (SSD), and to determine the value of MPVR and SSD in the diagnosis of calcaneal fractures.
Materials and Methods Patients suspected or diagnosed with calcaneal fracture were imaged conventional scans with SCT, then 47 fractures diagnosed with intraarticular calcaneal fracture were farther postprocessed with the techniques of MPVR and SSD to classify the fractures and to show the condition of involvement of joints and the numbers of fragments and so on.
Results Tuberosity slice showed the most involvement of articular facets in all cases. Coronal slice was superior to showing the medial and postenrior facets while involvment of the calcaneo-cuboid facets were defined most clearly in axial and tuberosity slice. The number of fragments was determined most reliably on the basis of the sagital reconstructions.The SSD version offered the spatial allocation of the individual slices, and well evaluated preoperatively the degree of joint injury and depression. Little displacement (only three fractures) of sustentaculum tali occurred. The severity of articular incongruity and rotational displacement of the posterior facet fragments were not well appreciated in coronal CT images of 11 fractures. Soft tissue abnormalities such as peroneal tendon could be clearly detected.
Conclusion Spiral CT SSD and MPVR have important value in the diagnosis of calcanenl fracture, they play an important role in the preoperative classification of calcaneal fractures, and are useful for the selection of surgical approaches, and for the evaluation of prognosis.
引文
[1]. Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot [J]. Clic Orthop,1993,292:128-130
[2]. Letcurnel E. Open treatment of acute calcaneal fractures [J]. Clic Orthop,1993, 290:60-62
[3]. Zmurko MG, Karges DE. Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures [J]. Foot Ankle Int,2002 Oct, 23(10):917-921
[4].俞光荣,梅炯,朱辉等.跟骨载距突的解剖特点及其临床意义[J].中国临床解剖学杂志,2002,20(1)：9-11
[5].梁军,胡滨成.跟骨的形态结构特点及其临床意义[J].中国临床解剖学杂志,2000,18(2)：118-120
[6].汤荣光,盛为,戴克戎.距下关节接触特征及其临床意义[J].中华骨科杂志,1999,19(8)：484-487
[7].杨云峰,俞光荣,梅炯.距下关节生物力学研究进展[J].同济大学学报(医学版),2003,24(1)
[8]. Hall RH, Shereff MJ. Anatomy of the calcaneus [J].Clin Orthop,1993, 290:27
[9]. Carr JB, Hamilton JJ, Bear LS.Experimental intra-articular calcaneus fractures:anatomic basis for a new classification [J].Foot Ankle,1989, 10:81-87
[10]. Carr JB. Mechanism and pathoantomy of the intraarticular calaneal fracture [J].Clin Othop,1993 May,290:36-40
[11]. Stephenson JR, Surgical treatment of displaced intraarticular fracture of the calaneus:anatomic basis for a new classification [J].Clin Orthop, 1993,290:68
[12].唐三元,徐永年,郑玉明.跟骨骨折[J].中国矫形外科杂志,1998,5(1)：63-64
[13].朱辉.跟骨骨折诊断与治疗进展[J].国外医学创伤与外科基本问题分册,2000,21(3)：138-141
[14]. Crosby LA, Fitzgibbon T. Intraarticular calcaneal fracture [J]. Clin Orthop,1993, 290:47-54
[15]. Monsey RD, Levine BP, Trevino SG, etal. Operation treatment of acute displaced intraarticular calcaneal fractures [J]. Foot Anklr Int,1995,16(20):57-59
[16]. Sanders R, Fortin P, Dipasquale T, etal. Operative treatment in 120 displaced intraarticular calcaneal fractures [J]. Clin Orthop,1993,290:87-95
[17]. Brudeaux BD. The medical approach for calcaneal fractures [J]. Clin Orthop,1993, 290:96-107
[18]. Eastwood DM, Gregg P J, Atkinhs RM. Intraartucular fracture of the calcaneus, part i. pathological anatomy and classification [J]. J Bone Joint Surg Br,1993, 75B:183-185
[19]. Zwipp H, Tscherne H, Thermann H, etal. Osteosynthhesis of displaced intraarticular fractures of the calcaneus[J]. Clin Orthop,1993,290:65-86
[20].王云钊,兰宝森.骨关节影像学[M].北京科学出版社,2002,1,18-26
[21]. Lowrie IG. Computerized tomographic assessment of the subtalar joint in calcaneal fractures[J]. J Bone Joint Surg Br,1988,70B:247-250
[22]. Segal D, March JL, Leiter B. Clinical application of computerized axial tomography (CAT) scaning of calcaneus fractures[J]. Clin Orthop,1985,199:114-116
[23]. Leas Heger, Krister Walff. Computed tomography of the calcaneus:normal anatomy[J]. AJR,1985 Jul,145:123-129
[24]. Johnson EE. Diagnosis and surgical treatment of intraarticular calcaneus fractures[J]. Orthopedics,1991,13(10):1091-1100
[25]. Wechsler RJ, Schneitzer ME. Helical CT of calcaneal fractures technique and imaging features [J]. Skeletal Radiol,1998 Jan,27(1):1-6
[26]. Miric A, Patterson BM, Ohio C. Pathoanatomy of intro-articular fractures of the calcaneus[J]. J Bone Joint Surg,1998 Feb,80A(2):207-212
[27]. Ebraheim NA, Biyani A, Padanilam T, etal. Calcaneocuboid joint involvement in calcaneal fractures[J]. Toot Ankle Int,1996 Sep,17(9):563-565
[28].施杞,王和鸣.骨伤科学[M].北京人民卫生出版社,2001：682-692
[29]. Kenneth J, Kval MD, Roy Sanders MD. The radiologic evaluation of calcaneal fractures[J]. J. B. Lippincott Company,1993 Num,290:14-46
[30]. Ebraheim NA, Biyani A, Padanilam T, etal.A pitfall of coronal computed tomographic imaging in evaluation of calcaneal fractures[J]. Foot Ankle Int, 1996Aug,17(8):503-505
[31].Leos Heger, Krister Wulff, M. S. A. Seddiqi. Computed tomography of calcaneal fractures[J]. AJR,1985,145:131-137
[32]. M. Freund, M. Thomsen, B. Hohendorf, etal. Optimized preoperative planning of calcaneal fractures using spiral computed tomography [J]. Eur. Radiol,1999, 9:901-906
[33]. S. TERRY CANALE[美]主编卢世壁主译.坎贝尔骨科手术学[M].济南山东科学技术出版社,2001,2：1878-1892
[34]. Letournel E. Open treatment of acute calcaneal fractures [J]. Clin Orthop, 1993,290:27
[35].荣国威.深入开展创伤骨科的临床研究[J].中华创伤骨科杂志,2002,4：164-166
[36]. Mittlmeier T, Morlock MM, Hertlein H, etal.Anlysis of morphology and gait function after intraarticular calcaneal fracture[J]. J Orthop Trauma, 1993,7:303-310
[1]. Arthur H, Newberg MD. Computed tomography of joint injuries. Radiologic Clinics of North America.1990:28(2):445-447
[2]. Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Clic Orthop.1993:292:128-130
[3]. Letcurnel E. Open treatment of acute calcaneal fractures. Clic Orthop.1993:290:60-62
[4]. Zmurko MG, Karges DE. Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures. Foot Ankle Int.2002 Oct:23(10):917-921
[5]. Hall RH,Shereff MJ. Anatomy of the calcaneus.Clin Orthop.1993:290:27
[6]. Carr JB,Hamilton JJ,Bear LS.Experimental intra-articular calcaneus fractures:anatomic basis for a new classification.Foot Ankle.1989:10:81-87
[7]. Carr JB.Mechanism and pathoantomy of the intraarticular calaneal fracture.Clin Othop.1993:May(290):36-40
[8]. Stone ML.Intraarticular calaneal fractures:current concepts.Clin Podiatr Med Surg.1995:12(4):551
[9]. Stephenson JR,Surgical treatment of displaced intraarticular fracture of the calaneus:anatomic basis for a new classification.Clin Orthop.1993:290:68
[10]. Crosby LA, Fitzgibbon T. Intraarticular calcaneal fracture. Clin Orthop. 1993:290:47-54
[11]. Monsey RD, Levine BP, Trevino SG, etal. Operation treatment of acute displaced intraarticular calcaneal fractures. Foot Anklr Int.1995:16(20):57-59
[12]. Sanders R, Fortin P, Dipasquale T, etal. Operative treatment in 120 displaced intraarticular calcaneal fractures. Clin Orthop.1993:290:87-95
[13]. Brudeaux BD. The medical approach for calcaneal fractures. Clin Orthop. 1993:290:96-107
[14]. Eastwood DM, Gregg PJ, Atkinhs RM. Intraartucular fracture of the calcaneus, part i. pathological anatomy and classification. J Bone Joint Surg Br.1993:75B:183-185
[15]. Zwipp H, Tscherne H, Thermann H, etal. Osteosynthhesis of displaced intraarticular fractures of the calcaneus. Clin Orthop.1993:290:65-86
[16]. Johnson EE. Diagnosis and surgical treatment of intraarticular calcaneus fractures. Orthopedics.1991:13(10):1091-1100
[17]. Wechsler RJ,Schneitzer ME. Helical CT of calcaneal fractures:technique and imaging features. Skeletal Radiol.1998:Jan:27(1):1-6
[18]. Kenneth J,Kval MD,Roy Sanders MD.The radiologic evaluation of calcaneal fractures.J.B.Lippincott Company.1993 Num 290:14-46
[19]. Ebraheim NA,Biyani A,Padanilam T,etal.A pitfall of coronal computed tomographic imaging in evaluation of calcaneal fractures.Foot Ankle Int.1996:Aug:17(8):503-505
[20]. M.Freund, M.Thomsen,B.Hohendorf,etal. Optimized preoperative planning of calcaneal fractures using spiral computed tomography.Eur.Radiol.1999:9:901-906
[21]. Letournel E.Open treatment of acute calcaneal fractures.Clin Orthop.1993:290:27
[22]. Mittlmeier T,Morlock MM,Hertlein H,etal.Anlysis of morphology and gait function after intraarticular calcaneal fracture.J Orthop Trauma.1993:7:303-310
[2]. Letcurnel E. Open treatment of acute calcaneal fractures [J]. Clic Orthop,1993, 290:60-62
[3]. Zmurko MG, Karges DE. Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures [J]. Foot Ankle Int,2002 Oct, 23(10):917-921
[4].俞光荣,梅炯,朱辉等.跟骨载距突的解剖特点及其临床意义[J].中国临床解剖学杂志,2002,20(1)：9-11
[5].梁军,胡滨成.跟骨的形态结构特点及其临床意义[J].中国临床解剖学杂志,2000,18(2)：118-120
[6].汤荣光,盛为,戴克戎.距下关节接触特征及其临床意义[J].中华骨科杂志,1999,19(8)：484-487
[7].杨云峰,俞光荣,梅炯.距下关节生物力学研究进展[J].同济大学学报(医学版),2003,24(1)
[8]. Hall RH, Shereff MJ. Anatomy of the calcaneus [J].Clin Orthop,1993, 290:27
[9]. Carr JB, Hamilton JJ, Bear LS.Experimental intra-articular calcaneus fractures:anatomic basis for a new classification [J].Foot Ankle,1989, 10:81-87
[10]. Carr JB. Mechanism and pathoantomy of the intraarticular calaneal fracture [J].Clin Othop,1993 May,290:36-40
[11]. Stephenson JR, Surgical treatment of displaced intraarticular fracture of the calaneus:anatomic basis for a new classification [J].Clin Orthop, 1993,290:68
[12].唐三元,徐永年,郑玉明.跟骨骨折[J].中国矫形外科杂志,1998,5(1)：63-64
[13].朱辉.跟骨骨折诊断与治疗进展[J].国外医学创伤与外科基本问题分册,2000,21(3)：138-141
[14]. Crosby LA, Fitzgibbon T. Intraarticular calcaneal fracture [J]. Clin Orthop,1993, 290:47-54
[15]. Monsey RD, Levine BP, Trevino SG, etal. Operation treatment of acute displaced intraarticular calcaneal fractures [J]. Foot Anklr Int,1995,16(20):57-59
[16]. Sanders R, Fortin P, Dipasquale T, etal. Operative treatment in 120 displaced intraarticular calcaneal fractures [J]. Clin Orthop,1993,290:87-95
[17]. Brudeaux BD. The medical approach for calcaneal fractures [J]. Clin Orthop,1993, 290:96-107
[18]. Eastwood DM, Gregg P J, Atkinhs RM. Intraartucular fracture of the calcaneus, part i. pathological anatomy and classification [J]. J Bone Joint Surg Br,1993, 75B:183-185
[19]. Zwipp H, Tscherne H, Thermann H, etal. Osteosynthhesis of displaced intraarticular fractures of the calcaneus[J]. Clin Orthop,1993,290:65-86
[20].王云钊,兰宝森.骨关节影像学[M].北京科学出版社,2002,1,18-26
[21]. Lowrie IG. Computerized tomographic assessment of the subtalar joint in calcaneal fractures[J]. J Bone Joint Surg Br,1988,70B:247-250
[22]. Segal D, March JL, Leiter B. Clinical application of computerized axial tomography (CAT) scaning of calcaneus fractures[J]. Clin Orthop,1985,199:114-116
[23]. Leas Heger, Krister Walff. Computed tomography of the calcaneus:normal anatomy[J]. AJR,1985 Jul,145:123-129
[24]. Johnson EE. Diagnosis and surgical treatment of intraarticular calcaneus fractures[J]. Orthopedics,1991,13(10):1091-1100
[25]. Wechsler RJ, Schneitzer ME. Helical CT of calcaneal fractures technique and imaging features [J]. Skeletal Radiol,1998 Jan,27(1):1-6
[26]. Miric A, Patterson BM, Ohio C. Pathoanatomy of intro-articular fractures of the calcaneus[J]. J Bone Joint Surg,1998 Feb,80A(2):207-212
[27]. Ebraheim NA, Biyani A, Padanilam T, etal. Calcaneocuboid joint involvement in calcaneal fractures[J]. Toot Ankle Int,1996 Sep,17(9):563-565
[28].施杞,王和鸣.骨伤科学[M].北京人民卫生出版社,2001：682-692
[29]. Kenneth J, Kval MD, Roy Sanders MD. The radiologic evaluation of calcaneal fractures[J]. J. B. Lippincott Company,1993 Num,290:14-46
[30]. Ebraheim NA, Biyani A, Padanilam T, etal.A pitfall of coronal computed tomographic imaging in evaluation of calcaneal fractures[J]. Foot Ankle Int, 1996Aug,17(8):503-505
[31].Leos Heger, Krister Wulff, M. S. A. Seddiqi. Computed tomography of calcaneal fractures[J]. AJR,1985,145:131-137
[32]. M. Freund, M. Thomsen, B. Hohendorf, etal. Optimized preoperative planning of calcaneal fractures using spiral computed tomography [J]. Eur. Radiol,1999, 9:901-906
[33]. S. TERRY CANALE[美]主编卢世壁主译.坎贝尔骨科手术学[M].济南山东科学技术出版社,2001,2：1878-1892
[34]. Letournel E. Open treatment of acute calcaneal fractures [J]. Clin Orthop, 1993,290:27
[35].荣国威.深入开展创伤骨科的临床研究[J].中华创伤骨科杂志,2002,4：164-166
[36]. Mittlmeier T, Morlock MM, Hertlein H, etal.Anlysis of morphology and gait function after intraarticular calcaneal fracture[J]. J Orthop Trauma, 1993,7:303-310
[1]. Arthur H, Newberg MD. Computed tomography of joint injuries. Radiologic Clinics of North America.1990:28(2):445-447
[2]. Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Clic Orthop.1993:292:128-130
[3]. Letcurnel E. Open treatment of acute calcaneal fractures. Clic Orthop.1993:290:60-62
[4]. Zmurko MG, Karges DE. Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures. Foot Ankle Int.2002 Oct:23(10):917-921
[5]. Hall RH,Shereff MJ. Anatomy of the calcaneus.Clin Orthop.1993:290:27
[6]. Carr JB,Hamilton JJ,Bear LS.Experimental intra-articular calcaneus fractures:anatomic basis for a new classification.Foot Ankle.1989:10:81-87
[7]. Carr JB.Mechanism and pathoantomy of the intraarticular calaneal fracture.Clin Othop.1993:May(290):36-40
[8]. Stone ML.Intraarticular calaneal fractures:current concepts.Clin Podiatr Med Surg.1995:12(4):551
[9]. Stephenson JR,Surgical treatment of displaced intraarticular fracture of the calaneus:anatomic basis for a new classification.Clin Orthop.1993:290:68
[10]. Crosby LA, Fitzgibbon T. Intraarticular calcaneal fracture. Clin Orthop. 1993:290:47-54
[11]. Monsey RD, Levine BP, Trevino SG, etal. Operation treatment of acute displaced intraarticular calcaneal fractures. Foot Anklr Int.1995:16(20):57-59
[12]. Sanders R, Fortin P, Dipasquale T, etal. Operative treatment in 120 displaced intraarticular calcaneal fractures. Clin Orthop.1993:290:87-95
[13]. Brudeaux BD. The medical approach for calcaneal fractures. Clin Orthop. 1993:290:96-107
[14]. Eastwood DM, Gregg PJ, Atkinhs RM. Intraartucular fracture of the calcaneus, part i. pathological anatomy and classification. J Bone Joint Surg Br.1993:75B:183-185
[15]. Zwipp H, Tscherne H, Thermann H, etal. Osteosynthhesis of displaced intraarticular fractures of the calcaneus. Clin Orthop.1993:290:65-86
[16]. Johnson EE. Diagnosis and surgical treatment of intraarticular calcaneus fractures. Orthopedics.1991:13(10):1091-1100
[17]. Wechsler RJ,Schneitzer ME. Helical CT of calcaneal fractures:technique and imaging features. Skeletal Radiol.1998:Jan:27(1):1-6
[18]. Kenneth J,Kval MD,Roy Sanders MD.The radiologic evaluation of calcaneal fractures.J.B.Lippincott Company.1993 Num 290:14-46
[19]. Ebraheim NA,Biyani A,Padanilam T,etal.A pitfall of coronal computed tomographic imaging in evaluation of calcaneal fractures.Foot Ankle Int.1996:Aug:17(8):503-505
[20]. M.Freund, M.Thomsen,B.Hohendorf,etal. Optimized preoperative planning of calcaneal fractures using spiral computed tomography.Eur.Radiol.1999:9:901-906
[21]. Letournel E.Open treatment of acute calcaneal fractures.Clin Orthop.1993:290:27
[22]. Mittlmeier T,Morlock MM,Hertlein H,etal.Anlysis of morphology and gait function after intraarticular calcaneal fracture.J Orthop Trauma.1993:7:303-310