多层螺旋CT和MRI测量肩胛盂斜倾角的互补性初探

目的 探讨多层螺旋CT(MSCT)多平面重组(MPR)及MRI测量肩胛盂斜倾角的互补性.方法 收集成人肩胛骨干标本22侧及肩关节防腐湿标本24侧,用16层螺旋CT扫描仪扫描,多平面重组重建肩胛骨并测量肩胛盂斜倾角,得数据A组.收集MRI检查正常的肩关节病例50侧,取其斜冠状位T1WI显示肩锁关节的层面测量肩胛盂斜倾角,得数据B组.进行统计学处理.结果 肩胛盂斜倾角最小值91.10°,最大值118.50°,A、B 2组肩胛盂斜倾角数据分别为101.14°±4.66°和104.05°±7.72°.2种测量方法肩胛盂斜倾角值统计学上有显著性差异(P＜0.05).结论 MSCT的MPR法测量肩胛盂斜倾角与MRI测量值不同,前者略小于后者;MSCT和MRI 2种测量肩胛盂斜倾角方法结合具有重要的应用价值.     

多层螺旋CT不同重建技术在复杂腕关节损伤中的应用

目的探讨多层螺旋CT不同重建技术对复杂腕损伤的临床应用价值。方法对65例X线诊断腕关节多发骨折患者进行MSCT扫描,采集数据后进行薄层处理、多平面重建（multi-planarre construction,MPR）、容积显示（volume rendering,VR）重建,将重建结果与X线平片对比观察。结果与X线平片比较,MSCT不同重建图像能全面、直观地显示相应的腕关节骨折、脱位及关节腔内骨片情况。MSCT诊断不同重建技术与临床符合率均为100%。MSCT与X线平片对比P〈0.05,具有统计学意义。而MSCT各重建技术之间P〉0.05,不具有无统计学意义。结论多层螺旋CT对复杂腕关节骨折能提供更多直观、立体腕关节损伤的信息,应做为常规检查手段之一。     

多层螺旋CT对眶骨骨折法医鉴定的临床价值

目的 探讨多层螺旋CT(HR-MSCT)各向同性扫描及后处理技术在眶骨骨折法医鉴定中的临床应用价值。方法 对2012年1月至2013年6月,因眼眶外伤接受法医鉴定来本院就诊的80例,行多层螺旋CT原始图像并进行(多平面重建,MPR)后处理技术重组。比较MSCT与常规CT诊断结果。结果 直接骨折24(30.0%)例,爆裂骨折38(47.5%)例,复合骨折14(17.5%)例,未见骨折4(5.0%)例。常规扫描漏诊、误诊16例(20.0%)。80例眶骨骨折病例均经MSCT确诊。MSCT诊断与常规CT诊断结果存在显著统计学差异(χ2=34.0,P=0.001)。结论 多层螺旋CT能更真实显示眶骨骨折处结构,结合后处理技术可清楚显示鼻骨骨折的部位、范围,为法医鉴定及临床治疗提供可靠依据。     

多层螺旋CT三维重建在肋骨及肋软骨损伤中的诊断价值

目的总结分析多层螺旋CT(MSCT)三维重建技术在肋骨及肋软骨损伤中的临床诊断价值。方法选择2010-06—2012-11 60例肋骨及肋软骨损伤患者为研究对象,入组者均经平片和普通CT扫描检查未清楚显示损伤情况,后所有患者进行MSCT扫描,利用专业工作站进行MPR(多平面重建)和VR(容积再现)的三维重建。结果经MSCT三维重建具体诊断为:单处肋骨骨折损伤22例,多发肋骨骨折损伤38例,伴肋软骨骨折损伤5例,伴胸骨骨折3例;共155处损伤,完全骨折122根,不完全骨折33根;其中4¹0肋骨折比例77.42%明显高于其他位置,腋段骨折比例50.79%明显高于前肋、后肋骨折比例,差异有统计学意义(P<0.05)。结论 MSCT三维重建技术在肋骨及肋软骨损伤的诊断中应用价值极高,值得推广使用。     

多层螺旋CT各种后处理对鼻骨骨折法医鉴定的价值

目的：探讨多层螺旋CT (MSCT)各种后处理技术在鼻骨骨折法医鉴定中的临床应用价值。方法对本院2010年至2013年120例鼻部创伤患者多层螺旋CT原始图像进行多平面重建（MPR）和表面遮盖显示（SSD）后处理技术重组。结果120例受检病人中,检出骨折112例：单纯Ⅰ型31例、Ⅱ型31例、Ⅲ型粉碎性骨折24例、Ⅳ型骨缝分离型12例、单纯上颌骨额突骨折14例;软组织算法SSD显示107例,MPR显示109例。骨算法MPR显示骨折部位、范围优于SSD,在颌面部骨缝及骨孔显示方面逊于软组织SSD。结论多层螺旋CT能更真实显示鼻骨多发骨折处结构,结合后处理技术可以清楚显示鼻骨骨折的部位、范围、分型。骨算法多平面重组技术结合软组织SSD图像,可为法医鉴定及临床治疗提供较可靠依据。     

多层螺旋CT不同重建技术对肋骨骨折准确性诊断的价值

目的探讨多层螺旋CT不同重建技术对肋骨骨折准确性诊断的价值。方法对42例临床怀疑肋骨骨折的患者进行胸部正斜位检查和MSCT扫描,CT采集数据后进行薄层处理、多平面重建(Multi-planar reconstruction,MPR)、容积显示(Volume rendering,VR)重建,将重建结果与X线平片对比观察。结果 MSCT不同重建图像能全面、直观地显示X线漏诊的肋骨骨折线和X线不能显示的肋软骨骨折。MSCT不同重建技术与临床符合率高。MSCT与X线平片对比P<0.05,具有统计学意义。而MSCT各重建技术之间P>0.05,不具有统计学意义。结论多层螺旋CT对肋骨骨折能提供更多直观、立体的信息,为临床医师提供更加全面的参考资料。     

肩胛骨骨折的分类及手术治疗

目的 探讨肩胛骨骨折（scapular fracture,SF)的分类及手术治疗。方法 回顾分析自1996年1月-2001年1月收治的经手术治疗的16例SF的临床资料。其中行前后位X线检查者16例，侧位及腋窝位X线检查者5例，螺旋CT三维重建检查者12例。根据Hardegger的分型方法，体部骨折9处，肩胛颈骨折7处，盂缘骨折2处，盂窝骨折1处，肩胛冈骨折5处，肩峰骨折3处，喙突骨折2处。其中混合型骨折11例（68.8%)。伴有合并损伤者14例（87.5%)。通过前方入路，后方入路，后上入路及前后联合入路分别对不同类型的SF使用重建钢板或拉力螺钉等固定。结果 16例患者全部获得随访，随访时间12-60个月。平均18.6个月，根据Rowe的疗效评价标准，优11例，良2例，可1例，差2例，优良率为81%。术后主要并发症包括创伤性关节炎2例，异位骨化1例，肩关节不稳定1例。结论 （1）SF多由高能暴力所致，常伴有合并损伤。三维CT重建有助于明确骨折类型和选择治疗方法；（2）盂窝骨折台阶样移位在3-5mm以上，盂缘骨折合并肱骨头半脱位，某些体部爆裂骨折，肩胛颈骨折失稳及浮肩损伤等应行手术治疗；（3）手术治疗是一种安全有效的方法。严重SF至少需随访1年，才能确定功能预后。     

多层螺旋CT后处理技术在肩部损伤中的临床应用

目的探讨多层螺旋CT后处理技术在肩部损伤中的应用及临床价值。方法收集2016年10月至2017年3月本院收治的58例肩部损伤患者,所有患者均经X线片,CT薄层扫描,然后进行多平面重组和三维重建,最后进行图像比较分析。结果多平面重组可更全面显示骨折断面信息和微小病变,三维重建能立体显示骨折范围和方向。结论多层螺旋CT后处理技术可以发现病变的细节和程度,更直观和立体地显示肩部损伤的情况,对临床的诊断和治疗方案有重要指导意义。     

多层螺旋CT在骨关节疾病诊断中的应用价值

目的探讨多层螺旋CT二维和三维重建技术在骨关节疾病诊断中的应用价值。方法对57例骨关节疾病患者进行多层螺旋CT扫描，并进行二维多平面重建（MPR）和容积再现重建（VRT），分析病变的情况。结果MPR对骨关节疾病细节显示满意，可以多平面观察骨的密度、形态、大小变化及发现邻近软组织改变；而Ⅵ汀三维重建对病变的定位和空间关系理解更直观、立体、准确，简化了思维。结论多层螺旋CT对骨关节疾病诊断具有很高的应用价值。作为轴位图像的重要补充，2D-MPR和3D-VRT重建能更直观和立体地显示病变，两者结合使用，对临床治疗方案和手术方案的制订具有重大的指导意义。     

三维CT重建在肩胛骨骨折中的应用

目的 探讨三维CT重建在肩胛骨骨折治疗中的指导意义。方法 7例肩胛骨粉碎性骨折患者接受x线、CT扫描、三维CT重建检查，对骨折的严重程度进行评估，并据此制定最佳治疗方案。结果 7例中，4例累及肩胛颈，2例累及肩胛颈和肩胛盂，1例伴锁骨骨折；6例接受手术治疗。所有患者均获得随访，随访时间3个月-2年6个月，骨折平均愈合时间7-10周，肩关节功能恢复良好。结论 三维CT重建能多方位、立体、全面地显示肩胛骨骨折部位、程度。对骨折手术方案的制定、手术人路和内固定的选择有很强的指导意义。     

Scapular body fractures: results of operative treatment

The authors operated on 22 patients with scapular body fractures, with a mean age of 35 years. The minimal follow-up was 12 months. All patients were treated from the Judet posterior approach. The study included 14 cases of an isolated body fracture, three of scapular body fracture combined with fracture of the scapular neck and five of glenoid fossa fracture. In all 14 cases where a 3D computed tomography (CT) reconstruction was performed prior to operation, intraoperative findings corresponded to this reconstruction. In eight cases without preoperative 3D CT reconstruction, the correct type of fracture was identified in only two cases. We also identified three basic types of fractures of the lateral border of the scapula. The anatomical relationship between the glenoid fossa and scapular body, congruency and stability of the shoulder joint was achieved in all cases. The average constant score was 94.     

异形钢板的研制及其在肩胛骨骨折的应用

目的：设计一种用于治疗不稳定肩胛骨骨折的新型内固定钢板，并评价其近期疗效。方法：根据肩胛骨解剖特点以及对18例不稳定肩胛骨骨折患者的X线片和CT扫描及其手术观察，设计出适用于肩胛骨骨折内固定治疗的异形钢板。所有患者按Hardegger的骨折分型：肩胛骨体部骨折9例，外科颈骨折3例，解剖颈骨折1例，盂缘骨折3例，肩胛岗骨折2例。均行新型内固定钢板内固定。结果：18例均获随访，随访时间6～18个月，平均12个月。按Rowe评分系统评价术后功能：优14例，良3例，可1例。结论：本钢板设计合理，生物力学性能良好，适用于各型不稳定肩胛骨骨折。     

Bilateral scapular fractures in adults

Purpose

Bilateral scapular fracture is a very rare injury. Most of these fractures result from electrical shock or epileptic seizure. We treated six patients with such injuries, all of them caused by direct violence. The aim of this study was to report on the patients and to present an overview of the cases published so far.

Methods

Between January 2011 and August 2012, we treated six patients with bilateral scapular fractures (four men and two women, age range 20–78 years). Another 11 cases were found in the literature. All cases were analysed in terms of injury mechanism, fracture pattern and the manner of diagnosis.

Results

Our six patients increased the total number of recorded cases to 17 and the number of patients with traumatic bilateral scapular fractures from four to ten. In five of our cases, the injuries were classified as being the result of high-energy trauma. Computed tomography (CT) examination of the affected scapulae was performed in all six cases, in five in combination with 3D CT reconstruction; in one polytraumatised female patient, only axial CT scans were obtained. In all five high-energy trauma cases, bilateral fracture of the scapular body was recorded, of which one was classified as open. Four of the 11 cases found in the literature were caused by direct violence: in six patients, the fractures resulted from muscle spasms associated with epileptiform seizure or electrical shock, and one patient suffered a pathological fracture associated with amyloidosis. The most frequently recorded fracture in all 17 patients (34 fractures) was of the scapular body, i.e. 24 fractures, followed by 12 fractures of the glenoid fossa.

Conclusion

According to data in the literature, bilateral scapular fracture is a rare injury. One reason may be that the potential incidence is often neglected. With the increasing number of patients with polytrauma, the potential for scapular fracture should always be taken into account, together with the fact that this injury may be bilateral. Of vital importance in diagnosing these injuries is CT scanning, including 3D CT reconstructions.     

浮肩损伤手术治疗的内固定策略

目的 探讨手术治疗浮肩损伤的适应证、复位顺序、内固定方法及其疗效.方法 2000年1月至2008年1月.采用切开复位内固定治疗浮肩损伤患者19例,男13例,女6例,平均年龄31.6(18～62)岁;肩胛颈骨折合并锁骨骨折18例,肩胛颈骨折合并肩锁关节脱位1例.全部采用内固定治疗.取浮动侧卧位,先将患者体位向后浮动,变为侧仰卧位,复位固定锁骨后,X线透视检查锁骨及肩胛骨,如果此时肩胛骨也已复位,可以考虑仅固定锁骨即可而不必再内固定肩胛骨.如果肩胛骨未复位,或复位后不稳定,则将体位向前旋转变为侧俯卧位,取后路复位并固定肩胛颁,若存在肩胛骨等其他部位的肩胛骨骨折,应考虑同时复位固定.如果锁骨骨折无明显移位,则仅采用后入路复位固定肩胛骨.本组中肩胛骨与锁骨同时固定13例,单纯肩胛骨同定2例,单纯锁骨固定3例,1例合并肩锁关节脱位者采用张力带固定并行韧带修复.结果 17例患者获得随访,随访时间10个月～4年,平均26个月.骨折均获得临床愈合,平均愈合时间11.8(8～16)周.肩关节功能根据Rowe疗效评价标准,优11例,良4例,可2例,优良牢为88.2%.结论 切开复位内固定是治疗浮肩损伤的有效方法,但应根据骨折类型及移位程度选择复位顺序与固定方法.浮肩损伤大多须将两处骨折同时固定,以便于早期进行功能锻炼.手术时先复位固定锁骨后复位固定肩胛骨有利于手术完成,减小手术创伤.     

MSCT 3D-VR技术显示孤立性实性肺癌结节与周围支气管和血管的关系

目的探讨64层螺旋CT 3D-VR技术显示孤立性实性肺癌结节与周围支气管和血管关系的可行性。方法对21例经术后病理证实的孤立性实性肺癌结节患者,于CT增强扫描后分别运用2D重建技术（MPR、MIP）和3D-VR技术,对癌结节与支气管和肺动脉（PA）、肺静脉（PV）的关系进行分型（Ⅰ～Ⅴ）。采用双盲评分法评估2D重建、3D-VR技术显示结节与支气管和PA、PV关系的能力（4级）。结果支气管与PA受累之间呈正相关（χ2=11.28,r=0.67,P〈0.01）。3D-VR与2D重建技术对结节与支气管,结节与PV关系的显示能力无显著差异（P=0.32、0.07）。2D重建技术对结节与PA关系的显示能力优于3D-VR（P〈0.001）。结论 MSCT 3D-VR技术操作简便、快捷,且能直观显示孤立性实性肺癌结节与其周围支气管、肺动静脉间的空间关系。     

CT三维重建技术对肩胛骨骨折的诊断价值

目的：探讨螺旋CT三维表面遮盖法重建(surface shaded display，SSD)及容积重建技术(volume rendering technique，VRT)对肩胛骨骨折的诊断应用价值。方法：使用SIEMENS PLUS4螺旋CT机对20例肩胛骨骨折患者进行扫描，全部数据输入工作站进行SSD及VRT处理，并与X线、二维CT(2D CT)检查结果进行对照分析。结果：2D CT扫描的结果经临床与手术证实为临床诊断的重要依据，经统计学分析，X线检查及SSD的诊断准确率分别为94．44％和97．78％，假阴性率分别为17．65％和7．84％，X线检查的假阳性率为0．76％；VRT诊断正确率为100％。SSD、VRT检出骨折创伤的数量与X线、2D CT的结果差异无显著性意义，但是显示损伤的质量优于X线和2D CT。术后对8例进行3D CT复查，VRT能立体显示术后肩胛骨骨质及内固定物的形态与结构。结论：螺旋3DCT是诊断肩胛骨骨折的有效手段，可指导手术计划的制定和内固定物的选择，应作为诊断复杂性肩部骨折的首选方法。VRT对骨折术后内固定物的位置及复位效果的判断有较高的应用价值。     

Fractures of the scapular neck: diagnosis,classifications and treatment

Purpose

Fractures of the scapular, or glenoid, neck are strongly debated in the relevant literature. Analysis of the respective studies, however, revealed a considerable confusion in terms of definition, terminology and diagnosis. In addition, there are few studies, primarily case reviews, dealing in detail with these fractures. The aim of this article is to present detailed information about fractures of the scapular neck, based on the analysis of our own experience and of the published literature.

Material and methods

Our group of 17 fractures of the scapular neck comprised 14 men and three women, with a mean age of 38 years (range, 24–55). The authors diagnosed four fractures of the anatomical neck, nine fractures of the surgical neck and five trans-spinous fractures of the neck. Of these 17 scapular neck fractures, six fractures were treated non-operatively, and 11 fractures were operated on via the posterior Judet approach. The mean follow-up was 4.9 years (range, 1–11).

Results

Fractures in all six non-operatively treated patients healed without complications in the anatomical position and with full function of the shoulder. In 11 operatively treated patients, all fractures of the scapula and clavicle healed within three months. In nine cases the function of the shoulder was subjectively and objectively assessed as normal, and in the remaining two cases as fair.

Conclusion

The term “scapular, or glenoid, neck” covers three different types of fractures, i.e., fracture of the anatomical neck, fracture of the surgical neck and trans-spinous neck fracture. Fractures of the surgical neck are divided into stable, fractures with rotational instability and fully unstable fractures, depending on the integrity of the coracocacromial and coracoclavicular ligaments. Accurate diagnosis of fractures of the scapular neck requires 3D CT reconstructions. Undisplaced or minimally displaced fractures may be treated non-operatively, markedly displaced fractures constitute an indication for osteosynthesis via the Judet approach.     

Comparison of 2 versus 3 dimensional fracture mapping strategies for 3 dimensional computerized tomography reconstructions of scapula neck and body fractures

Fracture mapping has been used in the understanding of injury patterns in different bones. To our knowledge, there are no applications of this technique using three‐dimensional (3D) morphologic fracture characteristics. Previously, scapula fractures were mapped by transferring information from 3D computed tomography to a two‐dimensional (2D) template. Cole et al. determined that 3D Computerized Tomography (CT) scans were more reliable compared to plain radiographs in terms of scapular angulation, translation, and glenopolar angle measurements. Thus, we hypothesized that if there is a difference between fracture lines drawn in 3D and in 2D, then the 3D mapping would yield more accurate fracture patterns. We completed a retrospective, comparative study (evidence level III) utilizing CT imaging from a single center scapular registry. We studied ten patients with scapula fractures in whom bilateral CT scans were obtained. Fractures were mapped both two and three‐dimensionally, and we measured deviations between the fracture lines that were drawn with each approach. The measured deviations ranged from 10.4 mm to 28.0 mm when comparing 2D versus 3D techniques, with the mean deviation being 4.0 mm and 10.4 mm, respectively. Half of the 2D renderings possessed hidden fracture lines that were later revealed on 3D imaging. Three‐dimensional renderings were more accurate when compared to 2D fracture mapping methods. This more accurate technique will allow for better understanding of 3D morphology and provide a basis for future fracture mapping in any bone. Accurate mapping is important because surgical approach, reduction, fixation, and implant design and selection are based on fracture patterns. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:265–271, 2018.     

Fractures of the anatomical neck of the scapula: two cases and review of the literature

Anatomical neck fractures of the scapula are rare. The authors have found in the literature only four radiologically documented fractures of the anatomical neck of the scapula. Two of them were published by Hardegger et al., the third case was published by Arts and Louette. The last case, in fact only a radiograph and a rather poor 3D CT reconstruction of a fracture of the anatomical neck of scapula, was published by Jeong and Zuckerman. Together with author’s two patients, the group of radiologically verified anatomical neck fractures of the scapula comprises six cases in total (four men, one woman, one gender unspecified). Analysis of the radiographs showed that in all these cases, the fracture line separated only the glenoid fossa from the scapular body, with a short spike of the lateral border of the scapula. The proximal part of the vertical fracture line ran into the coracoglenoid notch, between the upper border of the glenoid and the base of the coracoid process. The distal part of the fracture line crossed the lateral border of the scapular body 2–4 cm distal to the inferior pole of the glenoid fossa. The gleniod fragment was always formed by the glenoid fossa and a short spike of the lateral border of the scapular body. In five cases, the glenoid fragment, together with the humeral head, was displaced distally and the humeral head came to lie below the level of the coracoid process. At the same time, the glenoid fragment rotated into a valgus position. Only in one case, did the radiographs fail to show valgus displacement and the fracture was angulated in the transverse plane. In all six cases, the subacromial space between the acromion and the humeral head was widened. All fractures were operated on via a Judet posterior approach. In five cases, the outcome of the operation was assessed at 3, 5, 12, 21 and 120 months after surgery, three-being rated as excellent or very good, one as good and one as poor.