应用CT三维重建和关节镜监视下治疗胫骨平台骨折

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1、应用CT三维重建和关节镜监视下治疗胫骨平台骨折　刘红光暨南大学医学院第六附属医院广东江门市　529031　　陈述祥　丁林坚　赵崇达[摘要]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分类法：Ⅰ型4例，Ⅱ型5例，Ⅲ型2例，Ⅳ型6例，V型3例，Ⅵ型2例。然后对每一例骨折在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。结果本组22例胫骨平台骨折3D重建图像分型与关节镜术中的判

2、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，所有病人膝关节功能恢复优良。根据ＨＳＳ膝关节评分标准:优18例(81.8%)，良2例(9.1%)，可2例(9.1%)。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。[关键词]胫骨平台骨折　关节镜内固定UsageofArthroscopicTechniqueandSpira1CTand3DRecons

3、tructionsinTreatmentoftheTibialPlateauFracturesHong-GuangLiu　Shu-xiangChenLin-jianDingchong-dazhaoDept.ofOrthopaedics,the6thAffiliatedHospitalofJiNanMedicalCollege,529000,GuangdongJiangMenchinaAbstract:Objective:Toapproachtheapplicationvalueofspira19CTand3Dreconstructionandarthroscop

4、ictechniqueintreatmenttothetibialplateaufractures.Method:　22caseswithtibialplateaufractureswereexaminedwithplainradiographsandclassifiedaccordingtoSchatzker’sclassification.ThereweretypeⅠin4cases,typeⅡin5cases,typeⅢin2cases,typeⅣin6cases,typeⅤin3cases,typeⅥin2cases.Thentheywerere-cla

5、ssifiedafterspiralCTand3Dreconstructionimages:anteroexternalquadrantin4cases,posterolateralquadrantin8cases,anteriomedialisquadrantin4cases,posterointernalquadrantin2cases,involvingininternalandexternalquadrantin4cases.Alltibialplateaufracturewerereducedandfixedwitharthroscopic-assis

6、tedand　3Dreconstructions.Result:22casesoftibialplateaufracturesre-classifiedbyspiralCTand3Dreconstructionimageswerecoincidencewiththatofarthroscopic-assistedopereation.15caseswereneededbonegraft.4caseswerefixedcancellousscrew.8caseswerefixedbyunilateralbuttressplate.4caseswerefixedbi

7、lateralbuttressplate.6　caseswerefixedbyunilateralbuttressplateandcancellousscrew.Alltibialplateaufractureswerefollowed-upin3monthsto2years.Thefunctionsofkneeofallcaseswererecoveredwell.AccordingtoHSScriterion,theoutcomewasexcellentin18cases,goodin2casesandfairin2cases.Conclusion:　Spi

8、ralCTand3Dre