数字化重建技术在肱骨近端骨折临床分型中的应用

摘要

Objective To explore the value of three-dimensional digital reconstruction techniques in the diagnosis and treatment of proximal humeral fractures. Methods From January, 2008 to May, 2010, 25 patients with proximal humeral fractures underwent preoperative examinations with conventional X-ray, plain CT scan and 3D-CT scan. Based on the two-dimensional gray-scale CT scan data in DICOM format, personalized virtual fracture models were reconstructed using Amira4.1 software and compared with the conventional imaging examination methods for fracture typing to identify the fracture classification. Personalized surgical treatment was implemented according to the typing of the fractures, and the patients were followed up postoperatively for 8 to 35 months (mean 21 months) for functional evaluation using the Constant-Murley score. Results In the 25 cases of proximal humeral fractures, plain X-ray examination obtained a clear diagnosis and classification of the fractures in 15 cases, and CT scan, three-dimensional CT, and personalized three-dimensional model reconstruction confirmed the diagnosis and classification in 20, 22, and 25 cases, respectively. The humeral fractures healed generally 6 months after the operation, and the patients showed a Constant-Murley score ranging from 70 to 100 (mean 88). Conclusions Preoperative personalized three-dimensional reconstruction of proximal humeral fracture can help obtain a more accurate diagnosis of the fracture type to facilitate the decision on the optimal surgical plan, surgical approach and internal fixation methods.%目的 探讨三维重建技术在肱骨近端骨折诊断治疗中的意义,以提高肱骨近端复杂骨折的诊疗水平.方法 2008年1月～2010年5月,对25例肱骨近端骨折病人术前进行常规X线平片(平片),CT平扫及三维CT检查.将CT扫描数据以二维灰度DICOM格式输入计算机,应用Amira 4.1软件重建个性化虚拟骨折模型,将个性化三维构建模型与传统影像学检查方法在骨折的分型上进行对照分析,以明确骨折的分型分类.根据不同类型的肱骨近端骨折选择具有针对性的手术治疗方法,术后对25例患者进行随访(8～35个月,平均21个月),随访采用Constant-murley评分标准进行功能评价.结果 25例肱骨近端骨折中,X线平片可明确骨折诊断及分型的为15例；CT平扫可明确骨折诊断及分型的为20例；三维CT可明确诊断及分型的为22例；个性化三维重建模型可明确诊断及分型的为25例.针对不同骨折类型,采用个性化手术治疗.术后患者肱骨骨折普遍于6个月后愈合,依据constant-murley评分,临床评分为70～100分,平均为88分.结论 术前利用CT数据源进行病人肱骨近端骨折的个性化三维构建,可直观、清晰地显示出复杂骨折的全部细节,能找出骨折小碎块的来源,有助于确定骨折分型.术前行个性化骨折三维重建,可弥补CT平扫与三维CT检查之间成像的不足,更精确骨折的诊断分型,便于临床医生在术前选择适当、合理的治疗方案、手术入路和内固定方法,以提高肱骨近端复杂骨折的诊疗水平.