多排螺旋CT多平面重建与表面遮盖显示肩胛骨复杂性骨折中的直观图像

背景：由于肩胛骨骨折结构复杂、重叠较多，X射线平片检查容易造成漏诊。随着多排螺旋CT及三维重建技术的应用，三维重建图像能够直观、立体、多方位地显示骨折特征。目的：探讨多排螺旋CT多平面重建和表面遮盖显示重建后处理技术在肩胛骨复杂性骨折中的应用价值。 方法：使用多排螺旋CT对26例肩胛骨复杂性骨折的患者行薄层扫描，全部数据输入计算机工作站上进行多平面重建和表面遮盖显示重建后处理，得到肩胛骨骨折部位高清晰度的三维图像后，从不同角度观察骨折线走行、骨折移位及成角情况，依据三维图像进行骨折分型及模拟手术入路。结果与结论：多排螺旋CT多平面重建和表面遮盖显示重建图像能多方位、立体、全面地显示肩胛骨骨折部位和程度，图像与手术中所见符合率为100%。26例均为2 处或2处以上复杂骨折，共有骨折81处。按Hardegger标准分型：肩胛骨体部骨折28处，肩胛颈骨折13处，盂缘骨折11处，盂窝中央横断骨折9处，肩峰骨折8处，肩胛冈骨折6处，喙突骨折6处。结果提示，多排螺旋CT多平面重建和表面遮盖显示重建图像显示肩胛骨复杂性骨折的图像直观，对于肩胛骨复杂性骨折的分型、手术入路及内固定器选择等方案的制定具有较高的应用价值，是诊断肩胛骨复杂性骨折的有效方法。

Visual images of scapular complex fracture on multi-slice spiral CT multiplanar reconstruction and shaded surface display

BACKGROUND: Due to the complex structure of the scapular fracture, X-ray plain film examination easily leads to misdiagnosis. With multi-slice spiral CT and three-dimensional reconstruction technology, three-dimensional reconstruction images can be intuitive, three-dimensional, multi-faceted to show fracture features.OBJECTIVE: To evaluate application value of multi-slice spiral CT multiplanar reconstruction (MPR) and shaded surface display (SSD) reconstruction in the scapular fracture.METHODS: Multi-slice spiral CT was used to scan 26 patients with complex fractures of the scapula. All data were entered into the computer workstation, followed by MPR and SSD reconstruction of post-processing to obtain the three-dimensional images of high-resolution. From different angles the fracture line courses, fracture displacement and angulation of the situation were observed, and fracture classification and simulation of surgical approach were performed based on three-dimensional image.RESULTS AND CONCLUSION: Multi-slice spiral CT MPR and SSD reconstruction image fully displayed the location and extent of scapular fractures, with accordance rate between image and actual condition of 100%. A total of 26 cases suffered two or more fractures for a total of 81 fractures. According to standard Hardegger classification, there were 28 cases of scapular body fractures, 13 of scapular neck fractures, 11 fractures of labrum, 9 of glenoid fossa central transverse fracture, 8 of acromion fracture, 6 of scapular fracture, and 6 of coracoid process fracture. Results suggest that multi-slice spiral CT MPR and SSD reconstruction image shows visual images of scapular complex fracture, which are significant for the classification of the scapula fracture type, surgical approach and fixation selection, and effective for the diagnosis of scapular complex fracture.