螺旋CT三维重建在肱骨近端移位骨折分型及治疗中的应用

目的探讨螺旋CT三维重建对肱骨近端移位骨折分型的影响及在肱骨近端移位骨折中的临床应用价值.方法收集经手术治疗的肱骨近端移位骨折20例,所有患者术前均接受X线片检查,同时行肩部螺旋CT扫描和三维重建.根据Neer分型法对骨折进行分型,比较X线片和螺旋CT三维重建两种方法对肱骨近端移位骨折分型诊断的正确率,并评价螺旋CT三维重建在肱骨近端移位骨折治疗中的作用.结果经手术证实20例中Neer二部分骨折4例、三部分骨折9例、四部分骨折7例,普通X线片对肱骨近端移位骨折分型诊断的正确率为55%(11/22),螺旋CT SSD、MPR结合二维CT横切面图像对肱骨近端移位骨折分型诊断的正确率为90%(18/20),两者比较有显著差异(P＜0.05),所有螺旋CT三维重建资料均对治疗具有指导作用.结论对有手术适应证者,术前行螺旋CT三维重建对肱骨近端移位骨折分型及决定治疗方案有重要的指导价值.

The Evaluation of Spiral CT and Three-dimensional Reconstruction in the Classification and Treatment of Displaced Proximal Humeral Fractures

Objective To investigate the clinical significance and influence of spiral computed tomography(SCT) and three dimensional(3-D) reconstruction of classification in displaced proximal humeral fractures.Methods Twenty cases of displaced proximal humeral fractures were examined preoperatively under X-ray and SCT,3-D reconstruction.On the basis of two group imaging methods including A group:common X-ray,B group:3-D reconstruction,multiplanar(MPR) of SCT and 2D-SCT all fractures were classified with Neer system,the true rate of fracture classification by use of two methods was compared with each other and clinic significance of SCT and 3-D reconstruction was evaluated.Results Based on operation 20 cases of displaced proximal humeral fractures were 4 cases Neer two part fractures,9 cases three part fractures,7 cases four part fractures.The truerate of common X-ray is 55%(11/20) and the true rate of 3-D reconstruction,multiplanar(MPR) of SCT and 2D-SCT is 90% (18/20) in displaced proximal humeral fractures,there was signigicant difference between two group imaging methods (P<0 05).All SCT and 3-D reconstruction play an important role in the treatment of displaced proximal humeral fractures.Conclusion In selective patients SCT and 3-D reconstruction can help to truly classify the displaced proximal humeral fractures,select the best surgical approach,prepare surgical instruments and explain the complexity of the fractures.