根据CT扫描及三维重建改良胫骨平台骨折的Schatzker分型

目的根据对胫骨平台骨折进行3D-CT检查,把Schatzker分型再分出若干亚型,方便制订治疗方案。方法选取265例胫骨平台骨折病例,所有病例均进行Schatzker分型,再行3D-CT检查。根据胫骨平台俯视图,把胫骨平台分为两柱四区,根据骨折累及各区情况,把Schatzker分型进一步分出亚型。对265例病例进行统计,分析各型及亚型的病例数和发病率。比较两种分型的漏诊率,比较两种分型对指导治疗方案的满意度。结果根据3D-CT检查,把Schatzker分型细分出亚型,我们称为改良的Schatzker分型。265例胫骨平台骨折有27例行CT检查后,常规Schatzker分型与改良的Schatzker分型结果不符合,不符合率为13.61%;两种分型正确率分别为86.4%和100%。所有265例患者中,2 8例根据常规Schatzker分型不需要手术,但根据改良的Schatzker分型需要手术,更改率为10.6%。结论根据3D-CT检查把Schatzker分型进行细分,使分型更详尽、直观,提高了胫骨平台骨折的检出率,减少了误判率,便于研究损伤机制、制订治疗方案以及评判预后。

Improve on Schatzker Type of Tibial Plateau Fractures by 3D-CT

Objective According to 3D-CT on fractures of tibial plateau,Schatzker type of tibial plateau fractures could be further divided into several subdivisions.It is more convenient to be judged and treated.Methods 265 cases with tibial plateau fractures were examined by Schatzker type,then examined with 3D-CT.On the plan form,the tibial plateau fracture were divided into two columns including four areas.The classification data of the 265 tibial plateau fractures were collected,analyzed the cases and compared the improvement Schatzker type with routine.Results According to 3D-CT,we divided Schatzker type into several subdivisions,that we called Improved-Schatzker type.Based on Improved-Schatzker type,265 fractures of tibial plateau,136 are mixed lateral column fracture,27 are columnae medialis fracture,in 102 both mixed lateral column and columnae medialis fracture,and among them,14 are type Ⅰa,4 are type Id,8 are type Ⅰa-d,40 are type Ⅱa,8 are type Ⅱd,31 are type Ⅱa-d,18 are type Ⅲa,3 are type Ⅲd,and 10 are type Ⅲa-d,et al.In the 265 tibial plateaus.27 cases,after 3D-CT,of which,the classification do not conform with improvement the Schatzker type,and the Rate of nonconformance is 13.61%.The diagnostic accuracy rates of the Improved-Schatzker type and routine is 100% and 86.4%.All the 265 cases,28 cases don′t need operation according to routine,but do need according to Improved-Schatzker type,and the change rate was 10.6%.Conclusion Improve on Schatzker type,according to 3D-CT,lead to a more detailed and direct classification,raised the accuracy of examination,and reduced missed diagnosis,and also can provide better researching in injury mechanism,help making therapeutic regimen,judge and precaution.