螺旋CT在跟骨关节内骨折各关节面受累诊断中的应用研究

目的：通过螺旋CT多平面及表面重建来探讨跟骨骨折的特征及其在跟骨各关节面骨折诊断中的临床应用价值。材料与方法：经CR或临床检查可疑或确诊跟骨骨折的患者，应用Light SpeedQ／iGE4层扫描机进行检查，对35例47侧跟骨关节内骨折行多平面及表面重建。对骨折进行分型，同时分析各关节面受累情况。结果：跟骨结节位扫描是显示各关节受累总数最多的一种方法（95／101），在准确显示后关节骨折（46／47）与轴位（39／47）间有统计学差别。冠状位重建是显示距下中（14／14）、后（47，47）关节面受累的较佳方法，但11侧（11／47）骨折后关节面压缩及旋转移位在冠状位上没有被准确的反映出来，而在矢状重建中则准确的被显示。约60％的患者未发现独立的前关节。跟骰关节的骨折在轴位（32／32）、结节位（32／32）得到较准确的显示。三维重建是观察骨折整体空间改变的一种方法。结论：螺旋CT重建在跟骨各关节面骨折诊断中具有很高的临床价值。

Applicable value of spiral CT In facets Involvement of intra-articular calcaneal fractures

Objective： To investigate the characteristics of calcaneal fractures with spiral CT multiplanar volume reconstruction （MPVR）, surface shaded display （SSD）, and to determine the effectiveness of MPVR and SSD in the diagnosis of calcaneal fractures. Materials and Methods： Patients suspected or diagnosed with calcaneal fracture were imaged by conventional scans with SCT, then 47 fractures diagnosed with intra-articular calcaneal fracture were further imaged with the techniques of MPVR and SSD to classify the fractures and to show the condition of involvement of joints. Results： Tuberosity slice showed the most involvement of articular facets in all cases and had difference in showing posterior facets with axial slice. Coronal slice was superior to show the medial and posterior facets while involvment of the calcaneo-cuboid facets were defined most clearly in axial and tuberosity slice. The severity of articular incongruity and rotational displacement of the posterior facet fragments were not well appreciated in coronal CT images of 11 fractures while could be very well showed in sagital construction. About 60% anterior facets were not visualised. The 3D reconstruction offered the spatial allocation of the individual slices, and well evaluated preoperatively the degree of joint injury and depression. Conclusion： Sprial CT 3D and MPVR have important value in the diagnosis of calcanenl fracture, 3D and MPVR play an important role in the preoperative classification of calcaneal fractures, and are useful for the selection of surgical approaches, and for the evaluation of prognosis.