CT 图像后处理技术结合磁共振成像对踝关节骨折分型及术后并发症的评估价值

摘要

目的：运用 CT 图像后处理技术结合磁共振成像（ MRI）检查对踝关节骨折进行准确地分型、分度，并探讨其对术后并发症的评估价值。方法收集2011年1月—2013年6月南昌市第二医院收治的踝关节骨折患者51例，行螺旋 CT 扫描，并运用图像后处理技术结合 MRI 检查对其进行 Lauge - Hansen 分型、分度；对术后关节的修复情况参考 Leeds 的 X 线评估标准分类，预测创伤性关节炎等严重并发症的发生率并追踪结果。结果51例踝关节骨折患者中，旋后（内翻）外旋型（SE）15例，旋前（外翻）外旋型（PE）9例，旋后内收型（SA）11例，旋前外展型（PA）7例，旋前背屈型（PD）9例。其中38例行手术治疗，按 Leeds 的 X 线评估标准，好20例，良13例，差5例。3例关节软骨明显损伤；2例关节间隙内异物清除不全。预测创伤性关节炎发生率为26,3%（10/38）。追踪观察12~18个月，术后创伤性关节炎实际发生率为13,2%（5/38）。结论 CT 图像后处理技术能直观、立体地显示踝关节骨折的形态，MRI 检查能明确显示韧带、关节软骨受损情况，两者结合能准确进行 Lauge - Hansen 分型、分度，指导临床制定完善的治疗计划，对术后关节修复的评估及预测严重并发症的发生有重要价值。%Objective To classify and index the ankle fractures and to evaluate its assessment value in postoperative complications by using CT post - processing technique combined with MRI, Methods 51 patients with ankle fracture admitted to the Second Hospital of Nanchang from January 2011 to June 2013 were selected, The patients were given spiral CT scan and the CT imaging post - processing technique combined with MRI was used to make the Lauge - Hansen classification and indexing of ankle fracture, The joint repair situation was classified by referring to the X - ray evaluation standards of Leeds and the incidence of seri-ous complications like arthritis was forecasted and the results were tracked, Results Of the 51 cases of ankle fractures patients, there were 15 cases of supination - eversion(introve - raion)(SE),9 cases of pronation - eversion(ectropion)(PE),11 ca-ses of supination - adduction(SA),7 cases of pronation - abduction(PA)and 9 cases of pronation - dorsiflexion(PD), 38 ca-ses were given surgery treatment,and according to Leeds X - ray real - time evaluation standard,20 were excellent,13 were good and 5 were poor, 3 cases had damaged articular cartilage and 2 cases had foreign body in the joint space, The predicted inci-dence of traumatic arthritis was 26, 3%(10 / 38), The patients were followed up for 12 to 18 months,and the actual incidence was 13, 2% (5 / 38), Conclusion CT post - processing technique can give a clear intuitional and stereoscopic view of the shape of ankle fracture,and MRI can show the damage of ligaments and cartilago articularis, Combination of the two methods can make the Lauge - Hansen classification and indexing accurately,which can be helpful to the establishment of clinical treatment pro-grams,and it also plays an important role in assessing the joint repair after operation and forecasting the occurrence of serious complications.