多排螺旋CT多模式重组在Pilon骨折术前检查中的应用

目的探讨多排螺旋CT（MSCT）多模式重组技术在踝关节损伤所致的胫骨Pilon骨折术前检查中的临床应用价值。方法对22例Pilon骨折，采用16层螺旋CT进行容积扫描，并应用高级工作站进行3D、最大密度投影（MIP）、容积再现（VR）、MIP及多平面重组（MPR）等重组技术观察关节面粉碎、塌陷及劈裂的程度、骨碎片游离情况，并按Ovdia—Beals五类分型法进行分型，与x线及手术结果对照。结果22例Pilon骨折的病例中，Ⅰ型4例，Ⅱ型3例，Ⅲ型4例，Ⅳ型5例，Ⅴ型6例，对比X线结果，MSCT改变了其中8例分型，其中15例进行手术治疗，手术入路根据CT扫描及重建结果确定，其中5例是在否定X线分型结果上重新制订，余7例为保守治疗，手术结果证实了MSCT分型的正确。结论MSCT多模式成像可清晰显示骨折的部位，骨折线的走行方向、骨质碎裂程度和移位的距离以及关节面塌陷情况等。其中3D成像显示骨折区表面状态较好，MPR可明确显示骨折处的内部细节，VR和MIP可以显示骨折部位的立体透明外观。MSCT多模式重组技术在Pilon骨折手术治疗前作为制订手术治疗方案具有重要的价值。

The clinical application of multi-model reconstruction with multi-slice spiral CT before the operation of pilon fractures

Objective To study the clinical value of multi - slice spiral CT（MSCT） with multi - model reconstruction in the treatment of pilon fractures. Methods Twenty two cases of pilon fractures were examined by plain radiography and then scanned by 16 slice spiral CT. The raw data were reconstructed with VR,MIP and MPR techniques and classified according to Ovdia - Beals methods. CT results were compared with the resuits of X - ray and operation. Results In all 22 cases, 4 cases were type 1,3 cases were type Ⅱ ,4 cases were type Ⅲ, 5 cases were type Ⅳ and 6 cases were typeⅤ. The results of MSCT was compared with that of X - ray. According to the result of MSCT, type was modified in 8 cases. Of the 22 cases of pilon fractures, 15 cases were treated with operations, 7 cases with conservative treatment. The operative approach was made according to the results of MSCT reconstruction. The operation in 5 of 15 cases were based on the results of MSCT type but not X - ray type and the operation confirmed this MSCT types. Conclusion Multi - model reconstructed imaging of MSCT can demonstrate the location of fractures, the routes of fracture line, bone fragments, the distance of fracture dislocation and the collapse of articular surfaces. MPR can distinctly demonstrate internal morphological changes of bones, VR and MIP demonstrate the stereoscopic shapes of fractures. Multi - model reconstructed imaging of MSCT is of great value for the operation of pilon fractures.