多种影像学技术在胫骨平台骨折诊断中的应用价值

摘要

目的：评价普通X线、多层螺旋CT（MSCT）三维重建和MRI在胫骨平台骨折诊断中的临床应用价值。方法收集我院胫骨平台骨折患者37例，全部患者均行膝关节DR正侧位、MSCT三维重建和MRI检查，对其影像资料进行汇总分析。结果 DR漏诊4例，分型错误2例；MSCT三维重建1例未见明确骨折线，而造成分型错误；MRI分型均与术后分型一致，但对于显示交叉韧带附着点撕脱骨折、骨折粉碎程度及碎骨块移位情况，DR与MRI没有MSCT三维重建满意；所有病例MRI显示均合并有不同程度的膝关节损伤，其中骨挫伤26例，关节软骨损伤33例，半月板损伤27例，前交韧带损伤24例，后交韧带损伤14例，内侧副韧带损伤19例，外侧副韧带损伤9例，髌韧带损伤7例，关节囊积液35例。结论普通X线、MSCT三维重建和MRI等多种影像学检查技术结合应用，既能提高胫骨平台骨折诊断及分型，又能对关节软骨、半月板、肌腱韧带等软组织损伤情况做出判断，完善对膝关节损伤情况了解，为临床制定治疗方案和术后膝关节功能的恢复具有重要意义。%Objective Evaluate the clinical application value of X-ray,MSCT three-dimensional reconstruction and MRI in tibial plateau fractures diagnosis.Methods Collect 37 tibial plateau fractures patients in our hospital,and analyze the imaging in-formation by DR knee joint AP&LAT,MSCT three-dimensional reconstruction and MRI.Results There are 4 missed diagnosis and 2 typing error by DR;1 typing error by inconspicuous fracture line by MSCT three-dimensional reconstruction;MRI typing is iden-tical with postoperative typing,however MSCT three-dimensional reconstruction is better than DR and MRI in view of cruciate liga-ment avulsion fracture,degree of fracture,broken bone block displacement;for all the cases,MRI shows that all patients had differ-ent degree of knee injury,including 26 bone bruise,33 articular cartilage injury,27 meniscus injury,24 anterior ligament injury,14 posterior ligament injury,19 medial collateral ligament injury,9 lateral collateral ligament injury,7 patellar ligament injury,35 joint effusion.Conclusion The combining application of X-ray,MSCT three-dimensional reconstruction and MRI will not only improve the diagnosis and typing of tibial plateau fracture,but also judge soft tissue injury of articular cartilage,meniscus,tendon and liga-ment which has great significance to make the clinical treatment plan and the recovery of knee joint function.