| 三维CT重建及MRI检查在复杂性胫骨平台骨折中应用的病例对照研究 |
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Received:August 16, 2011
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| 作者 | Author | 单位 | Unit | E-Mail |
| 徐云钦 |
XU Yun-qin |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
yx0501@yahoo.com.cn |
| 李强 |
LI Qiang |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 申屠刚 |
SHEN Tu-gang |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 李骥 |
LI Ji |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 王刚 |
WANG Gang |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 姚有榕 |
YAO You-rong |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 邓盼 |
DENG Pan |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 罗正理 |
LUO Zheng-li |
解放军第九八医院骨四科, 浙江 湖州 313000 |
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2012年25卷，第3期，第184-189页 |
| DOI：10.3969/j.issn.1003-0034.2012.03.002 |
| 基金项目:南京军区科技创新课题(编号:11MA009) |
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目的:评价三维CT重建及MRI在复杂性胫骨平台骨折中的临床应用价值。
方法:自2004年3月至2009年1月收治复杂性胫骨平台骨折71例,在常规行普通X线片检查的基础上,同时行MDCT扫描并三维重建及MRI检查,其中行双切口单钢板法治疗24例,男14例,女10例;年龄19～56岁,平均33.6岁;平均随访时间31.4个月;行膝内外侧双切口双钢板法治疗21例,男12例,女9例,年龄21～53岁,平均33.2岁,平均随访时间28.4个月;行膝前正中直切口双钢板法治疗26例,男17例,女9例,年龄22～57岁,平均35.3岁,平均随访时间23.6个月。对骨折定位、骨折粉碎程度、骨折移位程度、骨缺损程度显示的满意度及关节面塌陷、膝关节交叉韧带、侧副韧带及半月板损伤的阳性率进行比较。
结果:X线片、MDCT及MRI的满意度评分分别为:骨折部位,(1.04±0.20)、(1.82±0.38)、(1.12±0.33)分;骨折粉碎程度,(0.81±0.51)、(1.92±0.26)、(0.83± 0.60)分; 骨折移位情况,(1.23±0.48)、 (1.92±0.26)、(0.46±0.58)分; 骨缺损程度,(0.36±0.51)、(1.55±0.79)、(0.26±0.53)分; 关节面塌陷,16、61、12例; 交叉韧带伤,3、10、17例;半月板伤,0、0、6例;侧副韧带伤,1、1、8例。MDCT在显示胫骨平台关节面是否塌陷、交叉韧带胫骨附着点撕脱骨折、胫骨平台骨折位置、骨折粉碎程度及骨折移位程度上较X线片及MRI满意。MRI在显示膝关节交叉韧带、侧副韧带、半月板损伤、关节面软骨是否剥脱及骨挫伤方面较X线片及CT满意。
结论:MDCT并三维重建与MRI检查进一步丰富了基于X线片表现的胫骨平台骨折Schatzker 分型,MDCT与MRI检查有助于复杂性胫骨平台骨折的精确诊断与合理治疗方案的确定,MDCT与MRI有助于发现膝关节及关节周围隐匿性损伤,减少误漏诊。 |
| [关键词]:胫骨骨折 体层摄影术,X线计算机 磁共振成像 诊断 病例对照研究 |
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| Case-control study on MDCT and MRI for the diagnosis of complex fractures of tibial plateau |
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Abstract:
Objective:To evaluate the clinical value of MDCT and MRI in the diagnosis and treatment of complex fractures of tibial plateau.
Methods:From March 2004 to January 2009,71 patients with complex fractures of tibial plateau estimated SchatzkerⅢ,V and Ⅵ were included in the study. Their X-ray films,MDCT,MRI were analyzed and compared. Twenty-four patients(14 males and 10 females with a mean age of 33.6 years) were treated with double incision and single plate. Average follow-up period was 31.4 months. Twenty-one patients(12 males and 9 females with a mean age of 33.2 years) were treated with double incision and bilateral plates. Average follow-up period was 28.4 months. Twenty-six patients(17 males and 9 females with a mean age of 35.3 years) were treated with bilateral plates via genicular anterior midline incision. Average follow-up period was 28.4 months. The index such as diagnosis correction for fracture location,fracture comminuted degree,fracture displacement degree,bone defect degree,and positive ration for number of collapsed joint surface,injuries of cruciate ligament,collateral ligament and menisci of knee joint.
Results:The satisfaction score of X-ray flims,MDCT and MRI were(1.04±0.20),(1.82±0.38) and(1.12±0.33) separately for fracture positions;(0.81±0.51),(1.92±0.26) and(0.83±0.60) separately for fractures comminuted degree;(1.23±0.48),(1.92±0.26) and(0.46±0.58) separately for fracture displacement degree;(0.36±0.51),(1.55±0.79) and(0.26±0.53) separately for bone defect;the number of patients having collapse of tibial articular surface were 6,61 and 12 separately;the number of patients having cruciate ligaments were 3,10 and 17 separately;the number of patients having menisci injuries were 0,0 and 6 separately;the number of patients having collateral ligament injuries were 1,1 and 8 separately. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse,avulsion tibial fracture at the point of cruciate ligament,fracture comminuted degree and fracture displacement degree (P<0.01). MRI was the most sensitive method in the diagnosis of injuries of cruciate ligament,collateral ligament,menisci,the cartilage peeling of articular surface(P<0.01).
Conclusion:MDCT and MRI further detail the Schatzker classification based on X-ray films,which also conduce to make precise diagnosis and reasonable treatments. MDCT and MRI are more sensitive for the diagnosis of insidious damages around knee. |
| KEYWORDS:Tibial fractures Tomography,X-ray computed Magnetic resonance imaging Diagnosis Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐云钦,李强,申屠刚,李骥,王刚,姚有榕,邓盼,罗正理.三维CT重建及MRI检查在复杂性胫骨平台骨折中应用的病例对照研究[J].中国骨伤,2012,25(3):184~189 |
| 英文格式: | XU Yun-qin,LI Qiang,SHEN Tu-gang,LI Ji,WANG Gang,YAO You-rong,DENG Pan,LUO Zheng-li.Case-control study on MDCT and MRI for the diagnosis of complex fractures of tibial plateau[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(3):184~189 |
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