螺旋CT重建在胫骨平台骨折诊治中的价值

胫骨平台骨折是刨伤骨科常见骨折之．骨折涉及关节面，对膝关节功能影响大．处理不当容易出观膝关节僵直、骨性关节炎等严重影响患者生活和工作的并发症。治疗上需解剖复位关节面、保护骨折周围软组织、坚强内固定及早期活动膝关节。要达到上述要求，术前必须制定准确的手术计划。螺旋CT扫描及二维、三维重建可帮助手术医生发现骨折、明确骨折类型及严重程度，对制定术前计划有重要意义。     

CT三维重建对胫骨平台骨折的诊断价值

胫骨平台骨折属于关节内骨折,常规以X线诊断为主。由于胫骨平台骨折复杂,临床诊断误诊率、漏诊率较高,难以达到预期的治疗效果。2014年5月~2018年5月,我科收治64例胫骨平台骨折患者,笔者探讨CT三维重建诊断的应用效果及价值,报道如下。1材料与方法1.1病例资料本组64例,男44例,女20例,年龄20~72岁。胫骨平台骨折分型:Ⅰ型17例,Ⅱ型15例,Ⅲ型11例,Ⅳ型10例,Ⅴ型7例,Ⅵ型4例。     

螺旋CT多维重建在胫骨平台骨折中的应用价值

胫骨上端骨质相对疏松，容易被股骨髁撞击，造成平台塌陷移位及交叉韧带断裂。因膝关节结构复杂，骨折块相互重叠，X线片及CT断面像很难全面客观地显示关节内骨折和移位程度。2001年5月至2003年9月我院诊治胫骨平台骨折34例，所有病例均行螺旋CT薄层扫描，采用多平面重建(MPR)、表面遮盖显示(SSD)及容积漫游技术(VRT)重建，对比分析螺旋CT多维重建在胫骨平台骨折中的应用价值。     

螺旋CT三维重建在胫骨平台骨折中的应用

目的探讨螺旋CT三维重建在胫骨平台骨折中的临床应用。方法回顾性分析1999～2004年38例胫骨平台骨折病例,手术前均行X线摄片,而后行螺旋CT三维重建并与手术对照。螺旋CT的扫描参数为层厚2～5mm,床速3～5mm,重建间距1.5～3mm。结果所有病例螺旋CT三维重建明确地显示了骨折,螺旋CT三维重建在骨折的分型和碎骨的描述上较平片优越,与手术中所见一致。结论螺旋CT三维重建能够更为精确地显示胫骨平台的骨折情况,对治疗方法的选择具有指导意义。     

MRI在胫骨平台骨折诊治中的意义

目的:探讨MRI在胫骨平台骨折诊治中的价值.方法:胫骨平台骨折患者63例,所有患者都行MRI及X线检查,评价胫骨平台劈裂和塌陷的程度,骨折断端是否有软组织嵌入,以及合并的韧带和半月板损伤,以选择合适的治疗方案.结果:所有患者都合并不同程度的韧带或半月板损伤,单纯劈裂骨折11例,单纯胫骨髁间骨折3例,49例患者有明显的胫骨平台塌陷,骨折端有软组织嵌入17例,X线未发现的隐性骨折7例.13例患者MRI检查后改变了治疗方案和手术方式.结论:MRI能清晰的显示X线不能显示的隐性骨折,并能同时显示骨折的形态和塌陷的程度,以及是否有软组织的嵌入和合并的半月板、韧带损伤,为治疗方案、手术方式和入路的选择提供详细的资料.     

多层螺旋CT对胫骨平台骨折分型的诊断价值

目的 探讨多层螺旋CT对胫骨平台骨折(TPF)分型的诊断价值.方法对89例(93侧)TPF的临床资料进行分析.结果93侧中20侧参考CT扫描结果后更改分型,X线片与多层螺旋CT正确率分别为78.49％和100％,差异具有统计学意义(x2=7.854,P＜0.01).28侧胫骨髁间棘骨折及15侧膝骨近端骨折在常规X线片检...     

螺旋CT在胫骨平台后侧骨折诊断中的作用

目的:探讨螺旋CT对胫骨平台后侧骨折诊断中的作用.方法:对56例胫骨平台后侧骨折患者行X线片和螺旋CT三维重建,分析CT在胫骨平台后侧骨折诊断和分型中的作用.结果:本组56例,CT分型:Ⅰ型10例(17.8%);Ⅱ型,后外髁劈裂骨折5例(8.9%);Ⅲ型,后外髁塌陷骨折16例(28.6%);Ⅳ型,后外髁劈裂塌陷骨折2例(3.6%);Ⅴ型,后内髁劈裂及后外髁塌陷骨折23例(41.1%).经X线片做出诊断47例,漏诊2例(3.6%),可疑4例(7.1%),3例X线提示裂纹骨折,CT扫描和三维重建显示粉碎骨折(5.4%).结论:螺旋CT检查在胫骨平台后侧骨折诊断、骨折分型、显示骨折移位程度和骨折碎骨片方面,均优于X线检查.     

多层螺旋CT在胫骨平台骨折诊断及Schanzker分型中的效果

目的探讨多层螺旋CT在胫骨平台骨折诊断和Schanzker分型中的效果。方法选取2017-01-2019-10间在西平县人民医院接受手术治疗的76例胫骨平台骨折患者,术前均接受多层螺旋CT检查。以手术所见为"金标准",统计多层螺旋CT检查对胫骨平台骨折诊断的符合率和Schanzker分型的符合率。结果本组多层螺旋CT对胫骨平台骨折的诊断符合率为94.74%(72/76)。对Schanzker分型的总符合率为90.79%,其中Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型、Ⅵ型的符合率分别为100.00%、100.00%、90.81%、81.58%、86.21%、73.33%。结论多层螺旋CT在胫骨平台骨折的诊断和Schanzker分型中有较好的临床价值,但尚有一定的误诊率,而且对Ⅳ型、Ⅴ型、Ⅵ型复杂胫骨平台骨折的Schanzker分型符合率相对较低,故对胫骨平台骨折的患者,尤其是复杂胫骨平台骨折的患者,应联合MRI检查。     

胫骨平台骨折CT分类的研究

目前,胫骨平台骨折分类包括:胫骨平台骨折三柱分型、胫骨平台骨折四象限分型、胫骨平台骨折八"段"分型和十"段"分型、四柱九段分型等。本文综述胫骨平台骨折各种CT分类的方法、优缺点和手术入路选择。胫骨平台骨折的CT分型的精髓更加注重冠状面骨折线,尤其后方的冠状面骨块。将胫骨平台关节面的四象限分类与胫骨平台周缘皮质的四柱分类相结合,再辅以非关节面结构(髁间棘、胫骨结节、腓骨头),有可能对胫骨平台骨折提供更加完整的描述,但也可能因为配对组合太多,太过繁杂,临床使用困难。     

CT三维重建在胫骨平台骨折诊疗中的应用价值

目的探讨三维CT扫描对复杂胫骨平台骨折的分型及治疗方法选择的临床应用价值。方法 2006年4月至2008年3月对36例胫骨平台骨折患者的临床资料进行分析。其中男21例,女15例;平均44.5岁(23～56岁);左侧16例,右侧20例。术前均投照患侧膝关节正、侧位X线片及CT扫描,并进行后期三维重建。按照胫骨平台骨折Schatzker分型方法,对普通X线片与结合CT扫描的两种分型结果进行比较。结果 36例中7例改变原有分型(18.3%),有4例最终依据CT图像分型改变手术入路和内固定方法。36例中经CT证实合并胫骨髁间棘骨折共7例(18.3%),而普通X线检查仅发现较明显移位的4例髁间骨折。结论 CT三维重建对胫骨平台骨折分型及临床治疗方法的选择具有重要指导意义。     

胫骨平台高能骨折的手术治疗

目的: 探索胫骨平台高能骨折手术治疗的临床疗效。方法: 回顾分析本院从 1997年 1月 ~2004年 3月共收治胫骨平台高能骨折即SchatzkerⅣ、Ⅴ和Ⅵ型骨折的 56例, 高能创伤造成的高能骨折均行切开复位“AO”钢板内固定治疗, 高能量创伤不仅对软组织损伤严重而且对肌肉有持续影响。结果: 随访 10个月 ~5年, 平均 1年 8个月。采用Merchant标准综合评定, 优良率达 85 .3%。结论: 胫骨平台骨折分型是高能骨折治疗的基础, 牢固可靠的内固定和早期正确处理软组织损伤是手术治疗和功能恢复的关键。     

Complications and unplanned outcomes following operative treatment of tibial plateau fractures

IntroductionThe operative management of tibial plateau fractures is challenging and post-operative complications do occur. The purpose of this study was three-fold. 1). To report complications and unplanned outcomes in patients who had sustained tibial plateau fractures and were operatively managed 2). To report predictors of these post-operative events 3). To report if differences in clinical outcomes exist in patients who sustained a post-operative event.MethodsOver 11 years, all tibial plateau fractures were prospectively followed. Clinical outcomes were assessed using the validated Short Musculoskeletal Functional Assessment (SMFA) score. Demographics, initial injury characteristics, surgical details and post-operative events were prospectively recorded. Student’s t-tests were used for continuous variables and chi-squared analysis was used for categorical variables. Binary logistic regression and multivariate linear regression were conducted for independent predictors of post-operative events and complications and functional outcomes, respectively.Results275 patients with 279 tibial plateau fractures were included in our analysis. Ten patients (3.6%) sustained a deep infection. Six patients (2.2%) developed a superficial infection. One patient (0.4%) presented with early implant failure. Two patients (0.7%) developed a fracture nonunion. Eight patients (2.9%) developed a venous thromboembolism. Seventeen patients (6.2%) went on to re-operation for symptomatic implant removal. Nine patients (3.3%) underwent a lysis of adhesions procedure. Univariate analysis demonstrated bicondylar tibial plateau fractures (P < 0.001), Moore fracture-dislocations (P = 0.005), open fractures (P = 0.022), and compartment syndrome (P = 0.001) to be associated with post-operative complications and unplanned outcomes. Long-term functional outcomes were worse among patients who developed a post-operative complication or unplanned outcome (P = 0.031).ConclusionOrthopaedic trauma surgeons should be aware of complications and unplanned outcomes following operatively managed tibial plateau fractures, along with having the knowledge of factors that are associated with development of post-operative events.     

复杂胫骨平台骨折的手术治疗

目的 探讨复杂胫骨平台骨折的手术治疗方法。方法 手术治疗复杂胫骨平台骨折48例，骨折类型按schatzker分型，其中Ⅲ型12例，Ⅳ型9例，V型14例，Ⅵ型13例，均经切开复位、钢板内固定，骨缺损者同时予以植骨。结果 48例中46例获1-4年随访，优良率77％。结论 复杂胫骨平台骨折宜手术治疗，手术方法根据不同的骨折类型而异。     

应用CT三维重建和关节镜监视下治疗胫骨平台骨折

目的:探讨应用CT三维重建和关节镜监视下治疗胫骨平台骨折中的价值。方法:收集22例胫骨平台骨折病例,术前常规进行X线摄片,按Schatzker分类:Ⅰ型4例,Ⅱ型5例,Ⅲ型2例,Ⅳ型6例,Ⅴ型3例,Ⅵ型2例。然后对骨折在3D重建图像后再分型:前外象限4例,后外象限8例,前内象限4例,后内象限2例,涉及内和外象限4例。在关节镜监视下结合3D重建对骨折进行复位和内固定。结果:22例胫骨平台骨折3D重建图像分型与关节镜术中的诊断一致。平台骨折需要植骨15例。松质骨螺钉固定4例,单侧支撑钢板内固定8例,双侧支撑钢板内固定4例,单侧支撑钢板加松质骨螺钉固定6例。随访3个月~2年,根据HSS膝关节评分标准:优18例,良2例,可2例。结论:螺旋CT及3D重建补充了在胫骨平台三维空间上新的骨折分型,对手术入路、复位和内固定有指导意义。关节镜监视下有助于骨折复位,对骨折块的血运干扰少,骨折愈合快。     

Balloon tibioplasty for tibial plateau fractures

BackgroundTibial plateau fractures are complex intra-articular injuries. The aim of treatment is to restore joint congruity and alignment. Balloon tibioplasty is a novel, minimally invasive technique to reduce the fracture and restore the continuity of the articular surface. A systematic review was performed according to the PRISMA guidelines in order to assess the outcomes from this procedure.Sources of dataThe online databases of Pubmed, Google scholar, the Cochrane Library, EMBASE and CINAHL were searched. Articles of interest were retrieved and evaluated, including case series, randomised controlled trials and cadaver studies.Areas of agreementEight studies (one randomised controlled trial, four case series and three cadaver studies) were included in the final review. The studies demonstrated adequate fracture reduction with favourable clinical and imaging outcomes from balloon tibioplasty. Very few complications were described.Areas of controversyThere is a small volume of literature currently available on balloon tibioplasty with an overall low level of evidence. The overall number of reported cases is also small.Growing pointsFurther research is necessary, with adequately powered randomised controlled trials. Further areas of research include type of bone substitute and the use of arthroscopically assisted surgery.     

Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures

PurposeTo determine factors influencing the development of posttraumatic osteoarthritis (OA) following medial tibial plateau fractures and to evaluate concomitant injuries associated with these fractures.Materials and methodsA chart review of patients with operatively treated medial tibial plateau fractures admitted to our Level I trauma centre from 2002 to 2008 was performed. Of 63 patients, 41 participated in a clinical and radiographic examination. The mean age was 47 years (range 16–78) and the mean follow-up time was 7.6 (range 4.7–11.7) years. All patients had preoperative computed tomography (CT) scans and postoperative radiographs. At the end of follow-up, standing radiographs, mechanical axis, and CT scans were evaluated.ResultsOf the 41 patients, 24 had no or mild (Kellgren-Lawrence grade 0–2) OA and 17 had severe (grade 3–4) OA. Initial articular depression measured from preoperative CT scans was a significant predictor of OA (median 1.8 mm vs 4.5 mm, p = 0.009). Fracture line extension to the lateral plateau (p = 0.68) or fracture comminution (p = 0.21) had no effect on the development of posttraumatic OA, nor did articular depression at the end of follow-up (p = 0.68) measured from CT scans. Mechanical axis >4° of varus and ≥2 mm articular depression or step-off were associated with worse WOMAC pain scores, but did not affect other functional outcome scores. Six patients (10%) had permanent peroneal nerve dysfunction. Ten patients (16%) required LCL reconstruction and nine (14%) ACL avulsions were treated at the time of fracture stabilisation.ConclusionsThe amount of articular depression measured from preoperative CT scans seems to predict the development of posttraumatic OA, probably reflecting the severity of chondral injury at the time of fracture. Restoration of mechanical axis and articular congruence are important in achieving a good clinical outcome.     

Arthroscopically assisted treatment for Schatzker type Ⅰ-Ⅴ tibial plateau fractures

Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures.
Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing.
Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3.
Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.