三维重建在骨盆和髋臼骨折中的应用

背景：骨盆和髋臼骨折诊断难度大，漏诊率高，临床上迅速和精确地诊断骨盆和髋臼骨折十分必要。且传统的骨盆和髋臼开放性手术创伤大、术中出血多，常常并发神经血管损伤，正确地定位和置入内固定器可减少手术的并发症。目的：旨在探究三维重建在骨盆骨折和髋臼骨折中的研究新进展，以促进其临床作用。方法：由第一作者应用计算机检索PubMed、中国期刊全文数据库（CNKI）、维普数据库1996年9月至2013年10月相关文献。在标题、摘要、关键词中以“三维重建，骨盆骨折，髋臼骨折”或“3D，three dimensional reconstruction，pelvic fracture，acetabular fracture”为检索词进行检索。排除重复研究或Meta分析类文章，最终纳入符合标准的文献41篇。结果与结论：三维重建通过多种后处理技术，如多平面重组、最大密度投影、表面遮盖显示和容积再现等可获得高质量、任意角度的图像，各种后处理技术优势互补，可减少骨盆和髋臼骨折漏诊率和误诊率。且三维重建技术可用于设计外科治疗入路，指导外科医师设计合理的治疗方案，模拟治疗流程，减少因内固定器错位而引起的并发症，降低治疗的风险，三维重建还用于治疗后随访复查，观察骨折恢复情况。

Application of three-dimensional reconstruction in pelvic and acetabular fractures

BACKGROUND： Diagnosis of pelvic and acetabular fractures is difficult with a high misdiagnosis rate. It is necessary to diagnose pelvic and acetabular fractures rapidly and accurately. And patients suffer great injury, blood loss, from traditional open pelvis and acetabulum surgery, often complicated by neurovascular injury. Correct positioning and placement of internal fixator can reduce surgical complications. OBJECTIVE： To explore the new progress of three-dimensional reconstruction of pelvic and acetabular fractures in order to promote its clinical application. METHODS： A computer-based online search of PubMed database, CNKI database and Vip database between September 1996 and October 2013 was performed to search related articles using the key words of ＂3D, three dimensional reconstruction, pelvic fracture, acetabular fracture＂ in English and Chinese, respectively. The duplicate research or Meta analysis articles were eliminated. Finally, 41 articles were enrolled for further analysis. RESULTS AND CONCLUSION： Through a three-dimensional reconstruction using a variety of post-processing techniques, such as multi-planar reformation, maximum intensity projection, shaded surface display and volume rendering, we can get high quality images at any angle. Various post-processing techniques interact with each other that can reduce missed diagnosis rate and misdiagnosis of pelvic and acetabular fractures. Moreover, three-dimensional reconstruction techniques can be used to design surgical approach, guide surgeon＇s surgicalprogram designed to simulate surgical procedures, reduce the complications caused by the dislocation of internal fixation, and reduce the surgical risk. Three-dimensional reconstruction is also used for postoperative follow-up review of fracture recovery.