胫骨下端爆裂性关节内骨折的CT三维影像重建

目的探讨三维ＣＴ影像重建在评估胫骨下端爆裂性关节内（Ｐｉｌｏｎ）骨折中的临床意义。方法收集自１９９４年１０月～１９９６年１０月间的Ｐｉｌｏｎ骨折患者１０例。所有患者均接受Ｘ线摄片、ＣＴ扫描和ＣＴ三维影像重建检查。根据以上３种影像学检查的显示，评估骨折的形态、骨折的碎裂程度及移位情况，对Ｐｉｌｏｎ骨折进行分类并选择合适的治疗方法。结果采用ＡＯ系统对骨折分类：Ｃ１型２例，Ｃ２型３例，Ｃ３型５例。４例在Ｘ线平片上显示关节面较完整，仅有轻度移位，但在三维ＣＴ影像和ＣＴ平扫中可见骨关节面不平整，有明显移位。６例患者在ＣＴ影像上可见骨折碎片数目多于平片，并有碎骨块的嵌插。根据三维ＣＴ重建对Ｐｉｌｏｎ骨折不同方位的立体显示，结合Ｘ线征和ＣＴ扫描对１０例患者均采用切开复位内固定，取得良好疗效。结论三维ＣＴ重建能多角度立体显示复杂的涉及关节面的Ｐｉ－ｌｏｎ骨折，弥补了Ｘ线平片和ＣＴ扫描等二维影像在这方面的不足，尤其是在显示关节面碎裂和移位的程度、碎骨块的嵌插及主要骨折线形态上，更是体现了三维影像和ＣＴ扫描的优点，是提高复杂关节内骨折诊断和治疗水平的有效手段之一。     

X 线摄片和 CT 扫描在脊柱骨折中的应用价值比较

目的：比较Ｘ线摄片和ＣＴ扫描在脊柱骨折中的应用价值。方法：分析了我院１９９３～１９９５年４６例脊柱骨折者的Ｘ线和ＣＴ表现，男３０例，女１６例，年龄２２～８０岁。结果：Ｘ线摄片和ＣＴ扫描发现，Ｘ线片对脊柱单纯屈曲压缩型骨折、椎体脱位、半脱位容易确诊，而对某些类型骨折较易误诊和漏诊，诊断符合率８１．６％。ＣＴ扫描可显示骨折部位、类型、骨折片的移位以及骨折片突入椎管，椎管狭窄，还能显示多节段椎体骨折和附件骨折。椎体骨折均为粉碎性。椎体后缘骨折片不同程度突入椎管，占４８％，与椎体骨折类型有关。ＣＴ扫描诊断符合率达９８．６％。结论：在脊柱损伤的诊断中必须Ｘ线摄片和ＣＴ扫描相结合才能提高脊柱损伤的诊断水平。     

髋臼骨折CT与X线平片检查比较

目的探讨CT与X线平片检查在髋臼骨折诊断中的临床应用价值。方法对照分析18例髋臼骨折CT、X线平片及临床治疗随访资料。结果18例髋臼骨折中前壁骨折4例,前柱骨折4例,后壁骨折2例,后柱骨折2例,复杂骨折6例。伴有盆腔内软组织肿胀11例。其中X线平片误漏诊4例。CT检出骨碎片27块,X线平片检出12块,其中关节腔内游离骨碎片CT检出17块,X线平片检出4块。股骨头脱位7例,伴股骨头骨折3例,其中X线平片漏诊1例。结论CT显示关节腔内碎骨片,确定骨折分型及了解盆腔软组织受损情况优于X线平片检查。     

三维CT在脊住骨折脱位中的应用

目的：对三维ＣＴ在脊柱骨折脱位中的临床应用价值作一初步探讨。材料和方法：比较１４例脊柱骨折脱位患者Ｘ线平片，ＣＴ扫描全部采用ＥＢＩＳＣ１５０ＸＰ型快速ＣＴ机，１．５ｍ层厚。扫描所得断层资料通过网络传送至计算机工作站进行处理。采用ＷｉｎｄｏｗｓＮＴ３．５１平台上Ｉｎｓｉｇｈｔ三维重建软件进行三维重建。结果：发现三维ＣＴ可通过三维空间内的任意旋转、切割，直观、清晰、精确地显示各种复杂脊柱骨折脱位的具体     

200例胸腰段椎体骨折的CT诊断

探讨ＣＴ在诊断椎体现骨折方面的价值。方法：先行ＣＴ定位片定位,后对骨折椎体行ＣＴ横断平扫,必要时行矢状面和冠状面椎管重建。结果：椎体骨折可分为：（１）单纯性压缩骨折;（２）粉碎性骨折? （３）骨折脱位三种类型。结论：ＣＴ可准确诊断各类椎体骨折,并分析椎体骨析的表现特点,为临床造反最佳治疗方案提供重要依据,同时和骨质疏松所引起的压缩骨折进行鉴别,有着Ｘ线平片不要比拟的优越性。     

寰枢椎损伤的CT诊断(附50例分析)

目的 探讨ＣＴ对寰枢椎损伤的诊断价值。方法 回顾性分析５０例寰枢椎损伤４ ＣＴ扫描资料。结果 寰椎骨折８例,齿状突骨折２４例,枢椎椎体骨折４例,枢椎椎弓骨折１１例,单纯性寰枢关节间脱位３例。ＣＴ全部诊断正确;Ｘ线平片诊断正确３４例。结论 ＣＴ能够清楚地显示寰枢椎骨折和脱位的情况,能准确确定骨折的类型和骨折的稳定性。ＣＴ是寰枢椎损伤最好的检查方法,应该常规应用。     

CT对隐匿对性骨折的诊断价值

大多数骨折可通过常规Ｘ线片作出诊断，但在少数情况下，却不易显示骨折征象以致延误诊断。对于那些不易被Ｘ线平片所发现的隐匿性骨折［１，２］，ＣＴ检查具有特异性。１资料与方法搜集本院１９９５年１月～１９９７年１２月２１６５例骨折病例，其中２０８９例摄Ｘ线片...     

胸腰椎骨折的CT诊断

目的：讨论胸腰椎骨折的ＣＴ诊断价值。材料和方法：分析５２例同时作ＣＴ和Ｘ线平片检查的胸腰椎骨折病例。结果：本组３７例为单椎体骨折，１５例为多椎体骨折，压缩型骨折占３８９％，爆裂型骨折占４５８％，骨折脱位型占１０％，安全带型占５６％。结论：ＣＴ对胸腰椎骨折诊断、分型及了解合并损伤方面有重要临床价值     

50例脊柱结核的CT及X线平片表现分析

选择５０例经ＣＴ诊断及手术病理证实的脊柱结核，对ＣＴ及Ｘ线平片表现进行回顾性分析，结果表明：ＣＴ发现椎体及附件骨破坏特别是较小较轻微的骨破坏及椎管内侵犯的能力、显示死骨及局限性脓肿的能力优于平片，能区别脓肿及肉芽肿。而Ｘ线平片显示椎间隙狭窄、脊柱滑脱等优于ＣＴ。结合文献讨论了与脊柱转移瘤的鉴别诊断。     

环枢椎脱位的CT及平片诊断

目的：研究环枢椎脱位平片及ＣＴ表现，比较它们的诊断价值。方法：２０例正常人，１３例环枢椎脱位和２例旋转性半脱位。均作常规ＣＴ扫描，５例加作功能性的ＣＴ扫描。结果：１５例环枢椎脱位和半脱位，平片诊断１５例，ＣＴ诊断１４例，漏诊１例。ＣＴ除显示环枢椎脱位外，还清楚显示合并的椎体多发性骨折部位、范围、骨性椎管的大小及畸形。结论：平片及ＣＴ均是诊断环枢椎病变的重要手段。平片难以显示复杂性骨折及骨性椎管形态的改变；ＣＴ对无移位的齿状突骨折和轻度环枢椎脱位不敏感。功能性的ＣＴ扫描是鉴别生理性和病理性环枢椎脱位的有效方法。     

不典型月骨周围脱位的影像表现及鉴别

目的：总结不典型月骨周围脱位影像特点及与相关骨折脱位的鉴别要点。方法本组16例不典型月骨周围脱位均摄有腕关节正侧位片,5例同时行64排CT扫描及重建,仔细观察分析每一病例的影像表现及特点。结果本组16例均为不典型月骨周围后脱位,伴不同程度月骨向前半脱位。单纯不典型月骨周围后脱位10例,其中同时伴舟骨后脱位3例,半脱位2例,无脱位5例,舟骨无脱位病例中,1例正位头舟间隙明显增宽;经舟骨不典型月骨周围脱位6例,除月骨向前半脱位外,舟骨骨折近段亦随月骨向前半脱位。结论单纯不典型月骨周围后脱位均伴有不同程度月骨向前半脱位,可伴或不伴舟骨后脱位;经舟骨不典型月骨周围后脱位,月骨及骨折近段同时向前半脱位。     

Dorsal fracture of the hamate: distinctive radiographic appearance

Six patients who injured their wrists had radiographs documenting a dorsal, 5- to 10-mm oblong fragment of bone immediately proximal to the base of the fourth and/or fifth metacarpal bones. The fragment was seen on the pronation oblique and/or lateral projections, but not on the posteroanterior projection. The radiographic appearance of the fragment was remarkably similar in all cases. In the one patient in which it was performed, pluridirectional tomography demonstrated that the fragment originated from the dorsal surface of the hamate. Five of the six patients also had associated posterior dislocation of the fourth and/or fifth metacarpals. We conclude that this fragment represents a coronal fracture through the body of the hamate resulting from posterior dislocation or subluxation of the fourth and/or fifth metacarpal.     

CT三维成像诊断寰枢关节不全脱位的临床价值

目的 评价CT三维成像对寰枢关节不全脱位的显示及诊断价值，探讨最佳三维成像方法。方法回顾性分析41例寰枢关节不全脱位的CT影像学表现，比较横断面图像、多层面重建(multiplanar reformatting，MPR)法、表面遮盖(surface shade display，SSD)法、最大强度投影(maximum intensity projection，MIP)法及容积重建(volume rendermg，VR)法三维图像显示的病变情况。结果寰枢关节不全脱位41例，其中旋转型脱位31例，前脱位5例，后脱位5例。影像学表现为上、下关节面错位41例，其中错位2～5mm 29例、5～9mm 12例；齿突侧距不对称15例；寰齿间隙增宽合并骨折8例。SSI)法三维影像直观显示移位的寰枢关节上、下关节面，齿突侧距不对称及寰齿间隙增宽；横断面图像和MPR、MIP及VR法三维图像显示移位的上、下关节面差、不直观。结论运用CT三维成像能准确显示及诊断寰枢关节不全脱位，并以SSD法三维成像最佳。     

CT三维重组诊断寰枢关节不全脱位的实验及临床研究

目的 比较寰枢关节的影像检查方法及技术，评价CT三维重组（CT3D）诊断寰枢关节不全脱位的临床价值。方法 实验研究寰枢关节骨标本1套，模拟出寰枢关节正常及脱位的模型，进行X线、常规CT及CT3D检查。前瞻性分析影像学特点及诊断准确率。临床患者87例进行中立位CT3D检查，其中28例加行左、右旋转位。分析CT3D显示脱位征象的特点及诊断寰枢关节不全脱位的临床效果。结果 实验组CT3D能清楚、直观的显示寰枢关节不全脱位各种征象，诊断准确率达100％。表面阴影法（SSD）CT3D显示寰枢外侧关节面错位最清楚，寰椎下关节面错位程度测量值与标本测量值差异无统计学意义（P〉0．05）。87例患者中诊断为寰枢关节不全脱位72例，其中旋转型脱位52例，前脱位13例，后脱位7例。中立位显示寰枢外侧关节面错位72例，旋转位显示为旋转固定8例，旋转不对称15例。结论 CT3D能显示寰枢关节不全脱位的各种征象，特别是寰枢外侧关节面错位。其中SSD法3D较X线、常规CT的诊断准确率高，具有成为诊断寰枢关节不全脱位金标准的条件。     

Peroneal tendon injury associated with calcaneal fractures: CT findings

Injury to the peroneal tendons is one of the major long-term complications of intraarticular calcaneal fractures and heretofore has been difficult to diagnose by noninvasive radiography. Retrospective review of CT scans of 24 intraarticular calcaneal fractures, obtained shortly after injury, identified 22 cases (92%) of acute peroneal tendon abnormalities. In most of these cases, multiple findings were present. These included lateral displacement in 14 (58%) of 24, impingement by bony fragments in eight (33%), subluxation or dislocation in six (25%), soft-tissue masses around the tendons representing hematomas or early scar tissue in five (21%), and entrapment of the tendons in three (13%). In 10 cases with long-term follow-up, impingement on the tendons by bony fragments correlated well with the subsequent development of peroneal tenosynovitis, while hematoma around the tendons or lateral displacement of the tendons was clinically insignificant. Thus, CT in the immediate postfracture period, can be used to detect and categorize acute peroneal tendon injuries as well as possibly to predict the likelihood and nature of subsequent development of peroneal tenosynovitis.     

Adolescent butterfly swimmer with bilateral subluxing sternoclavicular joints

Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed.     

Fixed posterior subluxation in posterior cruciate ligament-deficient knees: diagnosis and treatment of a new clinical sign.

Among 248 patients seen for posterior cruciate ligament insufficiency, 109 (44%) had fixed posterior subluxation of the tibia, defined as a condition in which posterior sag could not be reduced to a neutral position, as evidenced by posterior tibial displacement of 3 mm or more on anterior stress radiographs at 200 N. The mean fixed posterior displacement was 6.23 mm (range, 3 to 20). The fixed posterior subluxation was divided into three grades: I, 3 to 5 mm (57.8%); II, 6 to 10 mm (33.9%); and III, more than 10 mm (8.3%). Comparison of the 109 study patients with the 139 control patients revealed a history of a failed posterior cruciate ligament operation or of a patellar tendon harvest, male sex, and a long history of posterior cruciate ligament insufficiency as significant risk factors for the development of a fixed posterior subluxation. After patients were treated with a posterior tibial support brace, the fixed posterior subluxation could be reduced to a mean of 2.58 +/- 5.22 mm within an average treatment period of 180 days. Fixed posterior subluxation can be detected in patients with posterior cruciate ligament deficiency by anterior and posterior stress radiographs and should be addressed before posterior cruciate ligament reconstruction to prevent early overloading of the graft.     

Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography

The use of standard lateral roentgenography for diagnosing distal radioulnar joint (DRUJ) subluxation and dislocation was investigated. Using a wrist support, bilateral standard lateral roentgenograms of the wrist were obtained in 42 patients with normal wrists and in 56 patients with a unilateral wrist injury. In normal wrists the difference between the radioulnar distance in the right and the left wrist did not exceed 4 mm when the difference in the pisoscaphoid distance was less than 3 mm. Of the 36 patients with wrist injury whose difference in pisoscaphoid distance was less than 3 mm, 15 had a radioulnar distance of 5 mm or more, and computed tomography (CT) confirmed DRUJ dislocation in 14. Concordance between lateral roentgenograms and CT was present in 33 of 36 patients (92%). These results demonstrate the value of a standardized technique for bilateral lateral roentgenography in diagnosing DRUJ subluxation and dislocation.     

后-前路联合手术治疗下颈椎骨折脱位伴关节突交锁

目的探讨经后-前路联合手术治疗下颈椎骨折脱位、关节突交锁伴不全四肢瘫的疗效。方法44例下颈椎骨折脱位、关节突交锁伴不全四肢瘫患者,先侧卧位局部麻醉,经后正中切口暴露脱位节段的上椎板上缘至下椎板下缘,采用撬拨复位技术解除关节突的交锁;复位后可做两节段的侧块螺钉固定或棘突问钛线缆、钢丝固定(Stauffer法);然后变换体位为仰卧位,全身麻醉下经颈椎前路清除脱位椎间的椎间盘、上下终板,常规髂骨块植骨融合、钢板内固定。结果无围手术期死亡,无切口感染、喉返神经麻痹、内固定相关并发症,伤口均I/甲愈合。术后X线片示所有患者的脱位均完全矫正,无残留小关节半脱位和后凸畸形;未出现脊髓和(或)神经损伤加重者;术后14 d时改良Frankel分级明显改善。结论采用局部麻醉下后路切开复位固定再前路联合手术治疗下颈椎骨折脱位、关节突交锁伴不全四肢瘫是一种安全有效的方法,其优点为时间短、创伤小等。     

Concomitant dislocation and intraarticular foreign body: a rare complication of the Charnley total hip arthroplasty.

In the Charnley total hip arthroplasty, periarticular foreign bodies represent potential foci for intraarticular migration at the time of hip dislocation. This complication, although very rare, should be verified radiographically to prevent unsucessful attempts at closed reduction. Although intraarticular radiopaque foreign bodies should be identified on plain radiographs of the hip, intraarticular radiolucent foreign bodies require positive-contrast arthrography for identification. Two illustrative cases are presented.