电子束CT三维重建在髋臼骨折诊断与治疗中的应用

目的　探讨EBCT (电子束CT)三维重建在髋臼骨折诊断和治疗中的作用。方法　 12例髋臼骨折患者均行骨盆平片、EBCT平扫及三维重建检查 ,其中 7例行手术 ,比较以上三种方法的检查及术中情况 ,以显示各自的诊断价值。结果　①骨盆平片只能显示髋臼骨折 ,不能确定骨折类型。②EBCT平扫可以明确骨折类型 ,但需要阅片者有良好的空间思维能力 ,并熟悉髋臼周围的解剖结构。③EBCT三维重建可以得到髋臼骨折最直观、最全面的图象。结论　骨盆平片诊断髋臼骨折是粗浅的 ,对制定治疗方案帮助有限 ;EBCT平扫能显示骨折的详细情况 ,并由此选择合适的治疗方法 ,但要制定具体的手术方案 ,需要临床医生有丰富的阅片经验 ;EBCT三维重建对制定详细的手术计划可提供正确指导 ,是目前最理想的诊断髋臼骨折的方法。     

电子束CT三维重建在髋臼骨折诊断与治疗中的应用

目的：探讨ＥＢＣＴ（电子束ＣＴ）三维重建在髋臼骨折诊断和治疗中的应用。方法１２例髋臼骨折患者均行骨盆平片、ＥＢＣＴ平扫及三维重建检查,其中７例行手术,比较以上三种方法的检查及术中情况,以显示各自的诊断价值。结果①骨盆平片只能显示髋臼骨折,不能确定骨折类型。②ＥＢＣＴ平扫可以明确骨折类型,但需要阅片者有良好的空间思维能力,并熟悉髋臼周围的解剖结构。③ＥＢＣＴ三维重建可以得到髋臼骨折最直观、最全面的图     

借助CT三维重建手术治疗陈旧性髋臼骨折疗效观察

目的 探讨借助CT三维重建手术治疗陈旧性髋臼骨折的疗效.方法 借助CT三维重建手术治疗21例不同类型的陈旧性髋臼骨折.结果 21例均获得随访,时间10～38(25±2.07)个月.Matta影像学标准及功能标准评定:解剖复位优4例,复位良15例,复位差2例;功能优4例,良9例,可6,差2例.发生伤口感染1例,深静脉血栓1例,创伤性关节炎2例,异位骨化2例,股骨头坏死1例.结论 CT三维重建在治疗陈旧性髋臼骨折中起关键作用,可提高手术治疗效果.     

螺旋CT三维及四维重建在复杂性髋臼骨折的应用

目的：探讨螺旋CT三维及四维重建在复杂性髋臼骨折的应用。方法：使用Picker6000螺旋CT机对14例行患侧髋臼SCT扫描,在Voxel工作站上进行三维表面遮盖法重建,并以容积重建技术实现四维重建。结果：三维及四维重建图像清晰地显示了复杂性髋臼骨折细节,对骨折块大小、 移位程度得到了最直观、最全面的了解。结论：螺旋CT三维及四维重建对复杂性髋臼骨折诊断和治疗具有一定临床指导意义,是目前理想的诊断髋臼骨折的方法。     

三维CT重建在髋臼骨折诊断与治疗中的应用

髋臼骨折是一种较常见的骨折，且是累及关节面的骨折，以往根据X线片对其进行诊断、分型和手术，但髋关节是一个复杂的结构，特别是发生严重骨折后，正常的对位关系完全消失，X线片甚至是CT扫描很难使医生全面客观的了解骨折和移位程度，影响骨折分型和手术方案的确定，甚至漏诊、误诊。本院从1999年采用CT三维重建诊治髋臼骨折9例，并对其临床优点进行了探讨。     

螺旋CT加三维重建在髋臼骨折诊疗中的应用

<正> 髋臼骨折多系高能量损伤,常伴髋关节脱位或/和股骨头颈部的损伤。由于髋关节骨折的类型繁多,局部解剖关系比较复杂,仅依靠X线片和CT二维扫描难以全面、直观、清晰地反映骨折的情况,从而影响了治疗方法的选择和手术方案的制订。我们2001年1月～2003年6月对39例髋臼骨折常规行X线片、螺旋CT加三维重建检查,效果良好,报告如下。 1 临床资料 1.1 一般资料:本组39例,男25例,女14例,年龄18～61岁,平均41.5岁。致伤因素:交通事故伤31例,挤压伤3例,高空坠落伤2例,砸伤2例,合并骨盆骨折6例,内脏损伤2例,脊柱损伤2例,坐骨神经损伤1例,后尿道损伤1例。     

16排螺旋CT三维重建在泌尿系疾病诊断中的应用

2004年10月至2005年3月，我们用16排螺旋CT对泌尿系疾病患者进行腹部扫描时，获得尿系统三维重建成像26例，取得了良好的全尿路立体影像，现报道如下。     

螺旋CT三维重建在胫骨平台骨折中的应用

目的探讨螺旋CT三维重建在胫骨平台骨折中的临床应用。方法回顾性分析1999～2004年38例胫骨平台骨折病例,手术前均行X线摄片,而后行螺旋CT三维重建并与手术对照。螺旋CT的扫描参数为层厚2～5mm,床速3～5mm,重建间距1.5～3mm。结果所有病例螺旋CT三维重建明确地显示了骨折,螺旋CT三维重建在骨折的分型和碎骨的描述上较平片优越,与手术中所见一致。结论螺旋CT三维重建能够更为精确地显示胫骨平台的骨折情况,对治疗方法的选择具有指导意义。     

CT三维重建在踝关节骨折诊断和治疗中的应用

目的 探讨CT三维重建在踝关节骨折的分型诊断和治疗方面的临床价值.方法 42例踝关节骨折均行X线及CT三维重建检查,比较两者的检查结果,并根据CT检查结果确定最佳手术治疗方案.结果 CT三维重建诊断符合率为97.6％,X线为59.5％,CT三维重建诊断结果优于X线(P＜0.05).结论 CT三维重建对判断踝关节骨折移位、分型诊断优于X线,对手术路径和内固定方法的选择具有重要指导意义.     

Cementless acetabular reconstruction after acetabular fracture.

BACKGROUND: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture. METHODS: Thirty total hip arthroplasties were performed with use of a cementless hemispheric, fiber-metal-mesh-coated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture. The median interval between the fracture and the arthroplasty was thirty-seven months (range, eight to 444 months). The average age at the time of the arthroplasty was fifty-one years (range, twenty-six to eighty-six years), and the average duration of follow-up was sixty-three months (range, twenty-four to 140 months). Fifteen patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and fifteen patients had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis. RESULTS: Operative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis. Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods. Eight of the fifteen patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the fifteen patients who had been treated by closed means (p = 0.005). Two of the fifteen patients with a previous open reduction and internal fixation required bone-grafting of acetabular defects compared with seven of the fifteen patients treated by closed means (p = 0.04). The thirty patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 points at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39). Twenty-seven patients (90%) had a good or excellent result. There were no dislocations or deep infections. The Kaplan-Meier ten-year survival rate, with revision or radiographic loosening as the end point, was 97%. These results were similar to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis. CONCLUSIONS: The intermediate-term clinical results of total hip arthroplasty with cementless acetabular reconstruction for posttraumatic osteoarthritis after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especially in patients with previous open reduction and internal fixation. Previous open reduction and internal fixation predisposed the hip to more intraoperative instability but less bone deficiency.     

Virtual 3D planning of acetabular fracture reduction

Displaced acetabular fractures are best treated with open reduction to achieve anatomic reduction and maximize the chance of a good functional outcome. Because of the anatomic complexity and often limited visualization, fracture reduction can be difficult. Virtual planning software can allow the surgeon to understand the fracture morphology and to rehearse reduction maneuvers. The purpose of this study was to determine the effect of a novel virtual fracture reduction module on time and accuracy of reduction. Four acetabular fracture patterns were created in synthetic pelves, which were implanted with fiducial markers and were registered with CT scan. Ten surgeons used virtual fracture reduction software or conventional 2D planning methods and immediately reduced the fractures blindly in a viscous gel medium. 3D imaging was again performed and the accuracy of reduction was assessed. The average malreduction was significantly improved following planning with the virtual software compared to the standard technique. The time taken for reduction was also significantly less for two of the four fracture patterns. Virtual software may be useful for visualizing and planning treatment of fractures of the acetabulum, potentially leading to more accurate and efficient reductions, and may also be an effective educational tool. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:547–552, 2008     

Application of spiral CT image 3D reconstruction in severe talar neck fracture

Objective： To explore the application of the spiral computerized tomography （CT） image three-dimensional （ 3D ） reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods： Using the multi-slice spiral CT image 3D reconstruction technique, we analysed Ⅱ cases of talar neck fracture. The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results. In the Ⅱ cases, the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type Ⅱ. And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs, one of whom was misdiagnosed. After using the CT image 3D reconstruction, the 5 cases were classified exactly before osteosynthesis. The classifications of these Ⅱ cases were confirmed finally by surgical findings. The duration of operation were 45-Ⅰ40 min, averaging 8Ⅰ min （including the duration of C-arm fluoroscopy）. X-ray exposure time was 6-58 seconds, averaging 22 seconds. The blood loss was less than Ⅰ00 ml. The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred. Postoperative follow-up was from Ⅰ to 25 months. According to Hawkins score, excellent result was found in 6 type Ⅱ cases and Ⅰ type Ⅲ case; good result in I type Ⅲ case with both medial and lateral malleolar fracture, Ⅰ type Ⅲ with medial malleolus fractures and Ⅰ open type Ⅲ; fair result in Ⅰ open type Ⅳ with lateral malleolus fracture. Conclusions ： By using the multl-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures, the accuracy of diagnosis can be improved obviously. Based on this technique, more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.     

计算机三维重建技术在指导髋臼恶性肿瘤切除与骨盆重建中的应用

目的: 探究计算机三维重建技术在模拟骨盆、确定恶性肿瘤切除范围、假体个体化设计等方面的意义及实际应用效果。材料及方法: 女性髋臼软骨肉瘤1例, 病灶侵蚀髋臼底、髂骨、坐骨, 盆腔内软组织浸润约10cm。作病灶及骨盆的CT扫描, 计算机三维重建, 运用激光快速成型技术, 制出实物骨盆模型。根据模型确定截骨范围及截骨标志点, 模拟病灶切除。继续通过计算机, 制作与切除病灶相匹配的髋臼假体, 附带与周围骨盆组织完全服贴的固定柄。通过假体与患者肿瘤骨盆模型模拟手术与假体装备。取Smith Peterson及Radley联合入路, 显露髋关节、耻骨支、坐骨支, 按三维重建模型标志点切除肿瘤、植入预制假体; 假体分别以髂骨翼、耻骨、坐骨残余部分牢固固定。骨水泥固定髋臼内衬, 置换股骨头。结果: 手术时间约7h, 出血约2 000ml, 摄片示肿瘤缺损消失, 人工假体与骨盆和谐匹配, 髋关节活动良好。未出现神经损伤、深静脉栓塞、感染、脱位等现象, 患者恢复良好。结论: 计算机三维重建技术可以为髋臼肿瘤的恰当切除、匹配髋臼假体的个体化制作及骨盆的良好重建提供指导。     

多排螺旋CT三维血管成像在髋臼骨折诊疗中的价值

[目的]探讨多排螺旋CT维血管成像髋臼骨折诊断与治疗的意义,以提高髋臼骨折的诊疗水平.[方法]通过10例有明显移位的髋臼骨折进行术前CTA检查,明确骨折类型,髋臼周围动脉与骨折块的关系,然后制定手术方案和选择最佳手术人路.[结果]10例患者均获得12～24个月的随访,按照Matta疗效评定标准~[1],临床标准:优8例,良1例,可1例,优良率90%;X线标准:优7例,良1例,可2例,优良率80%,术中出血400 ml～1 500 ml,平均820 ml.[结论]多排螺旋CT三维血管成像能良好的显示髋臼骨折形态与类型、髋臼骨折块与髋臼周围动脉之间的关系及动脉的形态学改变、动脉内壁损伤情况,为髋臼骨折手术入路的选择与预后评价提供可视化的客观依据.     

三维"C"型臂透视导航下治疗髋臼骨折

 目的 探讨术中使用三维野C冶型臂透视导航下髋臼骨折微创治疗的安全性及临床疗效。 方法 2008年 8月至 2010年 12月, 对 20例无明显移位的髋臼骨折患者采用三维野C冶型臂透视导航 下经皮微创螺钉内固定治疗, 男 9例, 女 11例;年龄 26~54岁, 平均(37.1±1.2)岁。致伤原因: 交通伤 15 例, 高处坠落伤 5例。骨折按 AO分型: A1.1型 2例, A2.2型 3例, A2.3型 4例, A3.2型 2例, A3.3型 2例, B1.1型 2例, B2.2型 2例, B3.1型 1例,C2.1型 1例, C2.3型 1例。结果 伤后至入: 时间为 2~46h, 平均(8.6±0.2) h。入: 后行骨牵引 3~14d后手术。术中共置入空心钉 46枚, 平均每枚置入时间 为(22.6±1.2) min。除 1枚空心钉因术中采集图像时出现较大偏差需重新置入外, 其余均一次性准确置 入, 成功率为 97.8%。置入后术中使用三维野C冶型臂进行透视成像验证所有螺钉均未进入关节间隙, 与 术后 CT扫描验证结果一致, 符合率 100%。术后切口均一期愈合, 无内固定失败。 20例患者均获得随 访, 随访时间 12~28个月, 平均(22.8±1.7)个月。末次随访 X线片示骨折愈合, 螺钉置入位置满意。结论 术中三维透视成像导航下对无明显移位髋臼骨折进行经皮微创内固定, 可有效重建髋臼关节面的平整 性, 提高螺钉置入的精确度, 减少切口长度与出血量, 降低手术对患者的损害, 减少术后并发症的发生, 有利于患者功能康复。     

重建钢板内固定治疗髋臼骨折

[目的]探讨应用骨盆重建钢板内固定治疗髋臼骨折的疗效。[方法]回顾性分析25例重建钢板内固定治疗髋臼骨折的方法及临床结果。[结果]随访25例，随访时间最长4a，最短8个月。随访结果：优16列，良7例，可2例，3例坐骨神经损伤者有2例于术后6个月完全恢复，1例随访2a仍未完全恢复，无术后感染及死亡病例。[结论]骨盆重建钢板内固定治疗髋臼骨折，复位良好，固定可靠，并发症少，是一种治疗髋臼骨折的较好方法。     

CT三维重建在骨不连早期诊断中的应用

骨不连是骨折手术后常见的严重并发症之一,治疗比较为棘手,其早期诊断困难,X线片和二维CT扫描很难拿而客观地显示骨折愈合情况。目前,CT三维重建在骨不连早期诊断中的价值尚缺少系统和全面的评价。我院自2006年起应用CT三维重建早期诊断骨不连,取得了满意的效果。     

Midterm results of uncemented acetabular reconstruction for posttraumatic arthritis secondary to acetabular fracture

At an average of 6.3 years after surgery, we evaluated midterm results of uncemented acetabular reconstruction in 31 hips with posttraumatic arthritis that developed after acetabular fracture. Patients were categorized by previous fracture treatments (open-reduction group and conservative-treatment group) and fracture patterns (simple group and complex group). Surgery duration and blood loss were greater in the open-reduction and complex groups than in the conservative-treatment and simple groups (P < .05). The mean Harris Hip Score increased from 49 before surgery to 89 after surgery. Survival with revision or radiographic acetabular loosening as an end point was 100%. Fracture treatments and patterns were associated with increased surgery duration and increased blood loss. Open reduction and internal fixation of a fracture favor anatomical restoration of the hip's rotational center.