多层螺旋CT三维重建在脊柱骨折中的临床应用价值分析

目的:讨论多层螺旋CT三维重建在脊柱骨折中的临床应用价值。方法:将我院2018年4月—2019年4月,收治75例脊柱骨折患者作为研究对象,患者术前均经过多层螺旋CT三维重建与X线平片检查,比较两组诊断结果。结果:多层螺旋CT三维重建扫描前柱骨折、中柱骨折、后柱骨折的脊柱骨折部位检出率高于X线平片检查方式,P<0.05。多层螺旋CT三维重建扫描小关节滑脱、椎管狭窄、骨碎片、椎体骨折的脊柱损伤显示率高于X线平片检查方式,P<0.05。结论:多层螺旋CT三维重建对脊柱骨折的诊断更加准确,值得应用推广。     

CT在髋臼骨折诊治中的应用价值

目的：分析髋臼骨折CT及三维重建表现,探讨其临床应用价值。材料与方法：50例髋臼骨折均摄X线平片及CT横断扫描,其中45例采用SSD（表现遮盖法）或MPR（多平面重建）技术作三维重建,分析50例髋白骨折的横断及三维重建CT表现,根据Letournel分型将其分类,重点探讨三维重建的应用价值。结果：50例髋臼骨折中,①简单骨折22例,其中前壁骨折5例,前柱骨折3例,后壁骨折6例,后柱骨折4例,横行骨折4例,X线平片仅显示19例骨折。②复杂骨折28例,其中双柱骨折9例,T型骨折4例,后柱伴后壁骨折6例,前柱伴后半横行骨折4例,横行伴后壁骨折5例。CT横断扫描共显示关节腔内骨折碎片54块,X线平片仅显示关节腔内骨折碎片32块,并清楚显示软组织损伤情况,三维重建图像多角度,立体显示骨折及移位情况,50例髋臼骨折中,38例行手术治疗,12例保守治疗,手术所见与CT扫描结果完全一致。结论：髋臼骨折CT扫描能准确对骨折分型,三维重可弥补横断影像的不足,有助于骨折的立体定位,对治疗方案的选择及预后的提供客观依据。     

多排螺旋CT与图像后处理技术在外伤骨折中的诊断价值

目的探讨10排螺旋CT(10-MSCT)对外伤骨折的诊断价值及治疗的指导意义。方法对23例骨关节创伤病例X线平片检查后,应用10-MSCT扫描,在工作站上运用多平面重建(MPR)、三维重建(3D)等技术进行图像后处理,并对其进行诊断和分析。结果 5例X线平片显示局部骨皮质模糊或骨结构不清的病例,多排螺旋CT扫描后确诊骨折;2例X线平片诊断骨折可疑病例,MSCT扫描后排除骨折;4例X线平片未见明显骨折的病例,多排螺旋CT扫描后运用MPR、3D图像后处理技术后诊断为骨折;12例X线平片诊断为粉碎性骨折的病例,多排螺旋CT扫描后运用MPR、3D技术能从多方向显示各个骨折线的形态、方向、走形,撕脱、游离骨片的形态、大小以及骨折的移位、成角。结论 10-MSCT结合多种图像后处理技术可提高外伤骨折诊断的准确性,多排螺旋CT重建能清楚显示传统X线摄片所不能直接显示的骨折,对于术前的骨折分类、治疗方案的制定和手术路径的选择有一定的指导意义。     

16排螺旋CT三维重建诊断肩胛骨骨折价值

目的:探讨16排螺旋CT三维重建技术诊断肩胛骨骨折的价值.方法;回顾性分析36例肩胛骨骨折患者16排螺旋CT扫描经容积重建、多平面重建、表面遮盖显示等技术处理后获得的二维和三维重建图像资料,及肩胛骨X线平片影像资料.结果:16排螺旋CT三维重建图像诊断肩胛骨骨折36例(43处),其中≥2处复杂骨折6例,图像所显示骨折部位、移位、成角等情况均与术中所见一致.肩胛骨X线平片诊断肩胛骨骨折31例(36处),漏诊5例肩胛骨体部骨折均为无移位线性骨折.结论:16排螺旋CT三维重建对肩胛骨骨折诊断具有较高的临床应用价值.     

64层螺旋CT三维重建技术在舟状骨骨折的术前应用

目的研究64层螺旋cT三维重建技术对舟状骨骨折的诊断价值。方法分析36例舟状骨骨折患者的x线平片及64层螺旋CT资料,比较x线平片、CT轴位及三维重建三种图像对舟状骨骨折的诊断检出率,并对舟状骨骨折进行术前分型。结果cT三维重建技术对舟状骨骨折的检出率高于x线平片及CT轴位。按Herbert分型,稳定型骨折10例（27．78％）,不稳定型骨折26例（72．22％）。结论64层螺旋CT三维成像技术对舟状骨骨折的术前诊断、分型及指导治疗具有重要意义。     

螺旋CT骨三维重建诊断关节内骨折的价值

目的:探讨螺旋CT骨三维重建诊断关节内骨折的价值。方法:回顾性分析27例关节内骨折的X线、CT螺旋平扫和三维重建的表现,比较三者结果,评价三维重建诊断关节内骨折的价值。结果:X线平片发现关节内骨折25例,CT平扫、三维重建明确诊断关节内27例,显示平片漏诊的骨折块2例,此2例分别位于骶髂关节和髋臼缘,三维重建显示其骨折部位、范围及移位情况。结论:CT三维重建技术明显优于X线片和CT平扫,可提高关节内骨折的诊断水平。     

多层螺旋CT三维重建在骨关节损伤诊断中的应用

目的 评价螺旋CT及其三维重建技术在骨关节损伤中的临床应用价值.方法 2009年11月-2010年7月间,对46例骨关节损伤患者行多层螺旋CT扫描,重建三维图像.结果 多平面重建(multi-planar reformation,MPR)和容积再现三维成像技术(vo1ume rendermg technique,VRT)令人满意地显示出三维重建图像,CT发现9例X线平片上漏诊的多骨骨折,18例表面阴影显示法(shacled surface display,SSD)和VRT显示骨折线的长短、形态及走向.结论 螺旋CT扫描三维重建能直观地显示骨折的立体形态,对骨折的诊断、分类和指导治疗具有重要的临床应用价值.     

16排螺旋CT三维重建诊断肩胛骨骨折价值

目的:探讨16排螺旋CT三维重建技术诊断肩胛骨骨折的价值。方法:回顾性分析36例肩胛骨骨折患者16排螺旋CT扫描经容积重建、多平面重建、表面遮盖显示等技术处理后获得的二维和三维重建图像资料,及肩胛骨X线平片影像资料。结果:16排螺旋CT三维重建图像诊断肩胛骨骨折36例(43处),其中≥2处复杂骨折6例,图像所显示骨折部位、移位、成角等情况均与术中所见一致。肩胛骨X线平片诊断肩胛骨骨折31例(36处),漏诊5例肩胛骨体部骨折均为无移位线性骨折。结论:16排螺旋CT三维重建对肩胛骨骨折诊断具有较高的临床应用价值。     

X线平片与CT横轴位扫描诊断跟骨骨折的对比研究

目的评价X线平片、CT横轴位扫描诊断跟骨骨折的价值。方法回顾分析28例（36侧）跟骨骨折患者行跟骨X线侧轴位片及CT横轴位扫描的图像资料。结果X线平片发现20例,灵敏度71%,CT发现28例,灵敏度100%。单线骨折6侧,X线发现3侧、灵敏度50%,CT发现6侧、灵敏度100%。粉碎性骨折20侧,X线发现17侧、灵敏度85%,CT发现20侧、灵敏度100%。骨折移位20侧,X线发现12侧、灵敏度60%,CT发现20侧、灵敏度100%。骨折线累及关节面18侧,X线发现5侧、灵敏度27%,CT发现18侧、灵敏度100%。结论X线检查跟骨骨折图像相互重叠,难以清晰显示骨折情况,X线不能满足诊断跟骨骨折的要求。CT可直观、清晰显示跟骨骨折整体情况。     

薄层CT及多平面重建（MPR）技术对枢椎齿状突骨折的诊断价值

枢椎齿状突由于解剖及位置结构复杂，该部位的骨折X线平片极易漏诊。作者收集本院近年经X线平片及螺旋CT扫描确诊的30例枢椎齿状突骨折进行统计分析，以探讨薄层CT扫描及多平面重建（MPR）对枢椎齿状突骨折的诊断价值，并比较CT与X线对枢椎齿状突骨折的诊断能力。     

骶骨衰竭骨折的18F-FDG PET/CT显像分析

目的 探讨骶骨衰竭骨折的¹⁸F-FDG PET/CT显像特点。方法 回顾性分析接受¹⁸F-FDG PET/CT检查、诊断为衰竭骨折的8例患者的资料。结果 8例患者均发现骶骨有不同程度的异常放射性摄取增高,最大标准摄取值（SUV_max）为2.7~7.2。病变位于骶骨左侧翼4例、双侧骶骨翼及岬部2例、双侧骶骨翼1例、骶骨左侧翼及岬部1例;8例发生骶骨翼的纵行骨折,6例位于S1~2椎体,2例累及S3椎体,3例发生骶骨岬部的横行骨折,2例位于S2椎体,1例位于S3椎体;骶骨骨质密度增高5例、密度未见改变3例。结论 骶骨衰竭骨折的¹⁸F-FDG PET/CT显像有一定特点。     

MSCT平扫诊断下肢静脉曲张

目的 探讨256层MSCT平扫评价下肢静脉曲张的价值。方法 收集临床拟诊下肢静脉曲张患者40例,所有患者行下肢静脉的256层MSCT平扫+增强扫描,以CT增强为对照,评价CT平扫对下肢浅静脉曲张的检出情况。以患者临床体表征象为参照标准,评估单纯CT平扫图像对于皮肤表面显示不明显的皮下曲张静脉（即隐匿曲张静脉）的检出情况。结果 CT平扫评价曲张浅静脉与CT增强符合率为100%（54/54）,CT增强提示隐匿曲张静脉发生率为16.20%（35/216）,CT平扫图像显示隐匿曲张静脉与CT增强的符合率为100%（35/35）。结论 CT平扫对下肢浅静脉曲张的诊断价值与增强相似,对无法行CT增强扫描的患者,CT平扫可部分替代增强扫描。     

Is traumatic meniscal lesion associated with acute fracture morphology changes of tibia plateau? A series of arthroscopic analysis of 67 patients

BACKGROUNDComputed tomography (CT) has become a routine preoperative examination for tibial plateau fractures (TPFs). Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information; however, the evaluation of traumatic meniscal lesion (TML) and arthroscopic management are controversial.AIMTo predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT.METHODSAcute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study. The type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology included the following: Frontal fragment width of plateau, sagittal fragment subsiding distance (FSD), sagittal fracture line distance, sagittal posterior tibial slope, and transversal area ratio of fragment area) on preoperative CT three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.RESULTSA total of 67 patients were enrolled in this study, among which 30 patients had TMLs, lateral/medial (23/7). FSD was a particularly positive factor to predict TML, with odds ratio of 2.31 (1.26-5.63). On sagittal view of CT, FSD degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of TML in bicondylar TPFs. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs.CONCLUSIONTML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.     

骨盆功能不全性骨折18F-FDG PET/CT表现

目的 观察骨盆功能不全性骨折（PIF）¹⁸F-FDG PET/CT表现。方法 回顾性分析23例接受¹⁸F-FDG PET/CT检查的PIF患者,观察其PET/CT表现。结果 23例PIF中,17例为肿瘤患者,均未见明显骨转移;6例因排查肿瘤而接受检查,均排除肿瘤;其中20例（20/23,86.96%）为双侧、3例（3/23,13.04%）为单侧PIF,多累及骶、髂骨,少数累及耻骨;主要表现为骶骨翼或/和骶骨体或/和髂骨高密度影,部分病灶可见骨折线,累及耻骨时表现为局部骨质中断;病灶放射性摄取轻-中度增高,最大标准摄取值（SUV_max）为5.01±2.21,与肝脏血池平均标准摄取值比值（SUR-BP）为1.97±0.78。结论 ¹⁸F-FDG PET/CT中,PIF主要表现为骶骨翼或/和骶骨体或/和髂骨高密度影,部分病灶可见骨折线,累及耻骨时局部骨质中断,而无溶骨性破坏及周围软组织肿块形成,伴轻-中度放射性摄取增高,有助于与骨转移癌相鉴别。     

16层螺旋CT三维重建技术在髋臼骨折中的应用

目的：探讨16层螺旋CT三维重建技术在髋臼骨折中的应用。材料与方法：回顾性分析X线、16层螺旋CT证实的髋臼骨折患者80例影像资料。结果：所有病例16层螺旋CT扫描及重建均能显示骨折。横断面图像可以显示髋臼顶的骨折及移位、髋臼后壁骨折、受累范围及关节移位。三维重建立体显示骨折走行方向、骨碎片及股骨头移位情况。结论：16层螺旋CT对于术前充分了解损伤情况制定严格的手术计划具有重要的指导意义。因此,16层螺旋CT是髋臼骨折术前常规的检查手段。     

颌面部骨折CT检查的临床价值探讨

目的研究颌面部骨折的CT表现及其临床运用价值。方法回顾性分析256例颌面部骨折的CT表现。采用1.5～3.0mm层厚对感兴趣区进行薄层轴位扫描,观察鼻骨及眼眶细小骨折时,层厚为0.5mm,部分病例加扫冠位。后处理运用二维重建和三维重建。显示窗宽2000HU,窗位200～500HU。结果256例颌面部骨折分别为：鼻骨骨折35例 眼眶骨折63例,其中单纯爆裂性骨折57例,眼眶复合型骨折6例 颧骨骨折76例,其中单纯颧骨骨折16例,颧弓骨折60例 上颌窦壁骨折9例,其中6例为多壁多处骨折 下颌骨骨折6例,髁状突骨折2例,其中1例为双侧并伴双侧颞颌关节脱位 蝶骨骨折5例 62例为颧骨、眼眶、上颌骨等复合型骨折。CT轴位扫描诊断骨折252例,3例眼眶骨折可疑,1例鼻骨骨折阴性,经过二维和三维重建而清晰显示骨折。结论CT薄层轴位扫描显示颌面部骨折的敏感性高,二维和三维重建可以从多方位更准确、更直观的显示骨折,对临床的治疗方案选择具有重要价值。     

Modified cannulated screw fixation in the treatment of Pauwels type III femoral neck fractures: A biomechanical study

BackgroundAchieving satisfactory internal fixation for patients with Pauwels type III femoral neck fractures has become a critical problem. The purpose of this study was to compare a common standard internal reduction and fixation method for femoral neck fractures to the modified fixation methods.MethodsA computed tomography scan of the femur was performed to make a Three-dimensional (3D) model, and a fracture line was simulated in the femoral neck. 3Dfinite element analysis was carried out for different insertion methods of cannulated tension screws. Six healthy femur specimens were harvested from three formalin-fixed cadavers, and Pauwels type III femoral neck fracture was artificially created in bilateral femurs. The right side was treated with the inverted triangle construct method and the left side by the modified screw fixation method. After fixation, uniaxial compression and maximum load experiments on the bilateral femoral necks were carried out using the non-contact full-field dynamic strain measurement system (VIC-3D) on a pressure testing machine.FindingsBoth 3D finite element analysis and biomechanical study showed that the modified screw fixation method(group D) provided better anti-shearing and anti-rotation properties for Pauwels type III femoral neck fractures, and offered better interfragmentary compression. Therefore, this modified screw fixation method can offer patients a better option for treatment of Pauwels type III femoral neck fractures.InterpretationChanging the placement of the anterosuperior screw in the inverted triangle construct as perpendicular to the fracture line has the advantages in anti-shearing, anti-rotation and increasing interfragmentary compression.     

How to manage scaphoid waist fractures? Introduction of pragmatic imaging efficient pathway and literature review of the recent evidence

Introduction and ObjectiveThe scaphoid bone sustains about 90 % of carpal bone fractures and is the second-highest bone at risk of post-traumatic osteonecrosis. Delayed diagnosis and treatment could lead to non-union and advanced carpal bones collapse. This study aimed to introduce an imaging efficient and practical scaphoid waist fracture management pathway (SWFMP) and measure its efficacy in clinical practice.Materials and MethodsThe SWFMP was introduced in January 2020. Suspected occult fractures were approached by early orthopaedic clinical assessment and subsequent urgent MRI scan without repeating scaphoid X-rays. Scaphoid waist fractures displaced < 2 mm were treated with 8 weeks below elbow cast immobilization followed by CT scan if delayed union was suspected. Waist fractures displaced > 2 mm were managed with surgical fixation. Adult patients referred from the emergency department (ED) to the Virtual Fracture Clinic (VFC) with acute scaphoid injury from January 2019 to October 2019 (Pre SWFMP, n = 29), were identified and compared to those managed from January 2020 to October 2020 (Post SWFMP, n = 33).ResultsMean age was 37.9 (SD = 20.61) and 36.2 (SD = 17.06) years in the pre-SWFMP and post-SWFMP cohorts respectively. Fiften patients (51.7%) had the right side affected in the pre-SWFMP cohort and twenty-three patients (69.7%) in the post-SWFMP cohort. Scaphoid X-rays requested by ED have increased from 19 (65.5%) to 31 (94%) and repeated X-rays reduced from 17 (58.6%) to 10 (30.3%) after the introduction of the SWFMP. Mean wrist cast immobilization for patients without scaphoid fractures dropped from 16.9 days (SD = 5.57) to 3.6 days (SD = 6.24) after the SWFMP (p = 0.001). In the pre-SWFMP cohort, 24 patients had no fracture, 4 achieved full healing and 1 developed non-union. In the post-SWFMP cohort, 29 patients had no fracture, 1 achieved full union and delayed union was detected in 3 patients at 8 weeks.ConclusionsThe SWFMP has improved the clinical practice by reducing unnecessary ionizing radiation, unnecessary cast immobilization, and by using a timely fracture fixation intervention.     

骶骨功能不全性骨折的^99mTc-MDP SPECT/CT影像特征

目的:分析和总结骶骨功能不全性骨折(Insufficiency fracture,IF)的99mTc-MDP全身骨显像及骨盆SPECT/CT断层融合显像的影像学特征,探讨SPECT/CT的诊断增益价值。方法:回顾性分析21例经影像检查或临床观察、随访明确诊断为骶骨IF的临床及影像资料,分析两种影像检查在骶骨IF上的影像特征,对比二者的诊断准确性。结果:全身骨显像诊断15例(71.4%)骶骨IF骨折中,4例(26.7%)表现为单侧骶骨翼与骶髂关节平行走行的显像剂分布异常浓聚灶,其中有2例累及S2~S3骶骨体部;11例(73.3%)表现为双侧骶骨翼浓聚区形成的2条与骶髂关节平行的纵行带,其中8例(53.3%)同时累及S1~S4骶骨体部浓聚区形成的与骶髂关节垂直的水平带连接组成,表现为7例(46.7%)呈典型"蝶"形、"H"形,1例呈"弓"形。骨盆SPECT/CT断层融合显像上诊断骶骨IF 20例(95.2%),12例(60%)骶骨IF表现为双侧显像剂分布异常浓聚,9例(45%)在CT上可见双侧骶骨翼骨折,其中8例(40%)同时累及S1~S4骶骨体部,表现为双侧骶骨翼处走行与骶髂关节平行的低密度不规则"锯齿"状骨折透亮线影和/或硬化带、不均匀骨痂形成,骶骨翼边缘伴或不伴骨皮质不连续、轻微错位,骶骨体部横行骨折线走行与骶髂关节垂直;8例(40%)为单侧骶骨翼骨折,6例(30%)CT上显示为骶骨翼上走行与骶髂关节平行的模糊不规则低密度骨折线和硬化带,向前累及骶骨翼边缘伴骨皮质断裂、轻微错位,4例(20%)累及S2~S3骶骨体部骨折线走行垂直于骶髂关节。全身骨显像与骨盆SPECT/CT断层融合显像诊断骶骨IF的准确率分别为71.43%(15/21)和95.2%(20/21),骨盆SPECT/CT断层融合显像诊断骶骨IF准确率高于全身骨显像,差异具有统计学意义(P<0.05)。结论:全身骨显像上骶骨典型的"H"形、"蝶"形或"弓"形的显像剂异常浓聚可较容易诊断骶骨IF,但在不典型骶骨IF时,骨盆SPECT/CT断层融合显像能提高骶骨IF的诊断准确率,具有明显的增益价值。     

Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography

Background

Citing the enhanced resolution of 64-slice computed tomography (CT), some clinicians now use CT instead of magnetic resonance imaging (MRI) to detect occult hip fracture.

Objective

Our objective was to determine the incidence of occult hip fractures missed by 64-slice CT but detected by MRI.

Methods

We reviewed the medical records and radiology reports of patients over age 60 years with a hip fracture (acetabular, intertrochanteric, trochanteric, femoral neck, and femoral head) during a 3-year period, January 1, 2007 through December 31, 2009. We also reviewed all hip CT and MRI scans ordered during that period. Occult fractures were those visualized on CT or MRI but with negative plain films. We compared CT and MRI findings, and calculated percentages and 95% confidence intervals (CIs).

Results

Of 235 hip fractures, 211 were visible on initial plain films (90%, 95% CI 85–93%) and 24 (10%, 95% CI 6–15%) were occult. Eighteen occult fractures (7.6%, 95% CI 4.6–11.8%) were identified by CT (MRI not done), one (0.4%, 95% CI 0–2%) by MRI (CT not done), one (0.4%, 95% CI 0–2%) by both CT and MRI, and 4 patients (1.7%, 95% CI 0.5–4.3%) had a positive MRI but negative CT scan.

Conclusion

Although 64-slice CT detected the majority of occult fractures, it missed four (2%) significant fractures detected by MRI. CT scan is helpful in the diagnosis of occult hip fracture, but one should not completely exclude the diagnosis based on a negative 64-slice CT scan in a patient with persistent, localized hip pain who cannot bear weight.