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[1]黎金煥,陳躍平,董盼鋒,等.CT三維重建技術在橈骨遠端骨折術后評價中的應用[J].中醫(yī)正骨,2017,29(06):28-31,38.
　LI Jinhuan,CHEN Yueping,DONG Panfeng,et al.Application of 3D reconstructed CT imaging technique to postoperative evaluation of distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):28-31,38.
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CT三維重建技術在橈骨遠端骨折術后評價中的應用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年06期
頁碼:
28-31,38
欄目:
臨床研究
出版日期:
2017-06-20

文章信息/Info

Title:
Application of 3D reconstructed CT imaging technique to postoperative evaluation of distal radius fractures
作者:
黎金煥1; 陳躍平2; 董盼鋒2; 章曉云2; 袁振中1; 饒毅1
1.廣西中醫(yī)藥大學,廣西 南寧 530001; 2.廣西中醫(yī)藥大學附屬瑞康醫(yī)院,廣西 南寧 530011
Author(s):
LI Jinhuan1; CHEN Yueping2; DONG Panfeng2; ZHANG Xiaoyun2; YUAN Zhenzhong1; RAO Yi1
1.Guangxi University of Traditional Chinese Medicine,Nanning 530001,Guangxi,China 2.Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine,Nanning 530011,Guangxi,China
關鍵詞:
橈骨骨折;  腕損傷;  骨折固定術; 內(nèi);  放射攝影術;  體層攝影術; 螺旋計算機
Keywords:
Key words radius fractures;  wrist injuries;  fracture fixation; internal;  radiography;  tomography; spiral computed
摘要:
目的:探討CT三維重建技術在橈骨遠端骨折術后評價中的應用價值。方法:2012年1月至2016年6月,收治橈骨遠端骨折患者80例,男21例,女59例; 年齡20～80歲,中位數(shù)55歲; 左側38例,右側42例。均為閉合性骨折。骨折Melon分型,Ⅱ型21例、Ⅲ型23例、Ⅳ型19例、Ⅴ型17例。均由同一組醫(yī)生行前臂遠端掌橈側入路切開復位、掌側鎖定鋼板內(nèi)固定治療。術后第2天,拍攝腕關節(jié)正、側位X線片,并行CT三維重建檢查,對骨折復位情況及內(nèi)固定位置進行評價,并對2種方法的評價結果進行比較。結果:本組80例患者術后骨折復位情況評價,X線片上骨折解剖復位67例、未達解剖復位13例,CT三維重建片上骨折解剖復位50例、未達解剖復位30例; 2種方法評價結果總體比較,差異有統(tǒng)計學意義(χ2=9.191,P=0.002); 對MelonⅡ型患者的術后骨折復位情況進行評價,X線片上骨折解剖復位18例、未達解剖復位3例,CT三維重建片上骨折解剖復位12例、未達解剖復位9例,2種方法評價結果之間的差異有統(tǒng)計學意義(χ2=4.200,P=0.040); 但分別對MelonⅢ型、Ⅳ型、Ⅴ型患者的術后骨折復位情況進行評價,2種方法評價結果之間的差異均無統(tǒng)計學意義(χ2=1.075,P=0.300; P=0.269; P=0.259)。術后內(nèi)固定位置評價,X線片上內(nèi)固定位置良好65例、內(nèi)固定位置不佳15例,CT三維重建片上內(nèi)固定位置良好52例、內(nèi)固定位置不佳28例; 2種方法評價結果總體比較,差異有統(tǒng)計學意義(χ2=5.373,P=0.020); 但分別對各骨折分型(MelonⅡ型、Ⅲ型、Ⅳ型、Ⅴ型)患者的術后內(nèi)固定位置進行評價,2種方法評價結果之間的差異均無統(tǒng)計學意義(χ2=3.079,P=0.079; χ2=0.511,P=0.475; P=0.295; P=0.708)。骨折未達解剖復位者,多為粉碎的小骨塊,無法有效固定; 內(nèi)固定位置不佳者,主要為螺釘外露、穿透關節(jié)面或進入關節(jié)腔。結論:CT三維重建技術用于橈骨遠端骨折的術后評價,較X線檢查更有利于發(fā)現(xiàn)骨折復位不良和內(nèi)固定位置不佳。
Abstract:
ABSTRACT Objective:To explore the applied value of 3D reconstructed CT imaging technique in postoperative evaluation of distal radius fractures.Methods:Eighty patients with closed fracture of distal radius were recruited from January 2012 to June 2016.The patients consisted of 21 males and 59 females,and ranged in age from 20 to 80 years(Median=55 yrs).The fractures located in left radius for 38 patients and right radius for 42 patients.According to Melon classification of fracture,the fractures belonged to typesⅡ(21),Ⅲ(23),Ⅳ(19)andⅤ(17).Open reduction and volar locking plate internal fixation through distal antebrachial volar-radial approach were performed on all patients by the same group of surgeons.The results of fracture reduction and internal fixation were evaluated by taking anteroposterior and lateral X-ray films and 3D reconstructed CT images of wrist joints at postoperative day 2,and the evaluation results were compared between the the 2 methods.Results:The fractures reached anatomical reduction in 67 patients and did not reach anatomical reduction in 13 patients according to X-ray evaluation results,while the fractures reached anatomical reduction in 50 patients and did not reach anatomical reduction in 30 patients according to 3D reconstructed CT images.There was statistical difference in the evaluation results between the 2 methods in general(χ2=9.191,P=0.002).The Melon typesⅡfractures reached anatomical reduction in 18 patients and did not reach anatomical reduction in 3 patients according to X-ray evaluation results,while the Melon typesⅡfractures reached anatomical reduction in 12 patients and did not reach anatomical reduction in 9 patients according to 3D reconstructed CT images.There was statistical difference in the evaluation results between the 2 methods(χ2=4.200,P=0.040).However,there was no statistical difference in the evaluation results of postoperative reduction of Melon typesⅢ,ⅣandⅤfractures between the 2 methods(χ2=1.075,P=0.300; P=0.269; P=0.259).Sixty-five patients obtained a good internal fixation of fracture and 15 patients obtained a poor internal fixation of fracture according to X-ray evaluation results,while 52 patients obtained a good internal fixation of fracture and 28 patients obtained a poor internal fixation of fracture according to 3D reconstructed CT images.There was statistical difference in the evaluation results between the 2 methods in general(χ2=5.373,P=0.020).However,there was no statistical difference in the evaluation results of postoperative internal fixation of Melon typesⅡ,Ⅲ,ⅣandⅤfractures between the 2 methods(χ2=3.079,P=0.079; χ2=0.511,P=0.475; P=0.295; P=0.708).The unsuccessful anatomical reduction of fractures were mostly caused by comminuted small bone block which couldn't be effectively fixed.The poor internal fixation presented mainly with exserted screws and screws that penetrated the articular surface or entered into the articular cavity.Conclusion:3D reconstructed CT imaging technique is more conducive to find poor fracture reduction and internal fixation than X-ray examination in postoperative evaluation of distal radius fractures.

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備注/Memo

備注/Memo:
基金項目:廣西壯族自治區(qū)衛(wèi)生和計劃生育委員會自籌經(jīng)費科研課題(Z2015420); 廣西中醫(yī)藥大學自然科學研究項目(LX14015) 通訊作者:陳躍平 E-mail:[email protected]
更新日期/Last Update: 2017-06-20