胫骨平台骨折的平片与CT诊断

目的提高对胫骨平台骨折的X线平片及CT检查的认识水平。方法38例胫骨平台骨折,均行膝关节正侧位片及CT检查,其中33例行轴位螺旋CT扫描,然后行多平面和三维图像重组;5例单纯行轴位CT平扫,比较分析了胫骨平台骨折的X线和CT表现。结果38例中,胫骨平台后缘撕脱性骨折13例,胫骨髁间嵴撕脱性骨折8例,胫骨平台外侧髁骨折5例,胫骨平台单纯劈裂骨折3例,胫骨内侧髁骨折2例,胫骨平台单纯中央塌陷骨折2例,胫骨平台内侧髁骨折伴骨骺端骨折2例,胫骨平台内、外髁粉碎性骨折伴骨质塌陷2例,胫骨平台内侧髁不全骨折1例。全部病例CT片上均见合并骨折端软组织肿胀、出血,关节囊内积血,邻近脂肪间隙模糊、变形,关节囊内、皮下及邻近肌间隙积气。结论胫骨平台骨折的X线平片和CT检查,尤其是螺旋CT扫描后二、三维图像重组,对于指导临床判断手术指征和制定治疗方案,有重要意义。

Plain film and CT diagnosis in the fracture of tibial plateau

Objective To improve the cognition of plain flim and CT in the fracture of tibial plateau.Methods Anteroposterior and lateral position plain films and CT scan of knee joint were performed in all 38 cases fracture of tibial plateau,33 cases of which also underwent spiral CT scan,then,multiplanar and 3-dimensional(3D) recombination(MPR),only axial CT scan in other 5 cases.X-ray and CT findings were comparative analyzed.Results Among the of 38 cases,avulsion fracture of posterior border of tibial plateau 13 cases,avulsion fracture of tibial intercondylar eminence 8 cases,fracture of lateral condyle of tibia 5 cases,simple fissured frature of tibial plateau 3 cases,fracture of medial condyle of tibia 2 cases,simple collapased fracture of tibial plateau 2 cases,fracture of medial condyle of tibia combined with fracture of epiphysis 2 cases,comminuted fracture of medial and lateral condyle of tiabia combined with bone collapse 2 cases and infracture of medial condyle of tibia 1 case.Soft tissue damages,such as swelling and hemorrhage of soft tissue and intracapsular hematocele and hematoma,could be found on CT images in all cases.Opacity and distortion of adjacent fat spaces,intracapsular and subcutaneous as well adjacent spatium intermusculare pneumatosis could be showed on CT images.Conclusion X-ray plain film and CT examine in the fracture of tibial plateau,especially CT spiral scan,2-dimensional and 3-dimensional recombination those are very important on judging operative indictions and guiding clinical treatment.