多排螺旋 CT 三维重建技术在跟骨骨折中的应用价值探讨

摘要

Objective :To study the value of multiple detector computed tomo‐graphy(MDCT) and three‐dimensional reconstruction in the application of calcaneal fracture .Methods:47 calcaneal fractures in 44 patients with acute calcaneal fractures underwent multidetector CT .The post‐processing techniques included multiplanar reformation (MPR) ,maxi‐mum intensity projection(MIP) and volume rendering(VR) .The bone and the surrounding soft tissue were reviewed . Results:47 calcaneal fractures including 3 bilateral fractures were diagnosed by X‐ray ,MSCT ,VR ,MPR and MIP ima‐ges ,16 of them were single and 31 were complicated fractures .24 posterior articular surfaces and 7 cuboid articular sur‐faces involved in the complicated fractures .According to Sanders criterion the fractures of calcaneal involving the poste‐rior articular surface included type Ⅰ in 6 ,type Ⅱ in 27 ,type Ⅲ in 9 and type Ⅳ in 5 .While the sensitivity and accura‐cy of X‐ray were only 90 .32% and 93 .62% .Conclusion:Preoperative MDCT scan with thee‐dimensional reconstruction can exactly display the calcaneal fracture and classification ,and can accurately evaluate fracture shift condition and the tendons‐that is for surgical plan .%目的：探讨多排螺旋C T （M SC T ）三维重建在跟骨骨折中的应用价值。方法：对44名患者47例急性跟骨骨折的病人分别进行跟骨侧位、轴位X线摄片及MSCT 扫描与后期容积再现（VR）、多平面重建（MPR）、最大密度投影（MIP）等后处理，观察并统计不同检查手段对骨折线的显示情况，并对累及跟距关节面的跟骨骨折进行Sanders分型。结果：跟骨骨折47例，M PR和V R显示16例单纯跟骨结节骨折，31例复杂性骨折；累及跟距关节面复杂骨折24例，累及跟骰关节面复杂骨折7例。按Sanders分型分为Ⅰ型6例，Ⅱ型27例，Ⅲ型9例，Ⅳ型5例。单纯X线片显示19例单纯跟骨结节骨折，28例粉碎性骨折；X线对于跟骨是否粉碎性骨折诊断的敏感性、准确性分别为90．32％及93．62％，与M SC T三维重建显示结果有差异性。结论：在跟骨骨折的多项影像学检查方法中，M SC T 结合后期工作站三维重建技术能为跟骨骨折，尤其是粉碎性骨折患者的治疗方案提供准确、可靠的信息参考。