Navigation method of 64-slice CT reconstruction in tibial plateau fractures

doi:10.3969/j.issn.2095-4344.2016.26.019

Abstract

Abstract:

BACKGROUND: 64-slice CT reconstruction technique for tibial plateau fractures has obtained satisfactory results. This technology can reconstruct three-dimensional fracture relations, provide more scientific positioning and navigation standards for physicians, and improve the clinical cure rate. However, in the clinic, navigation method of 64-slice CT reconstruction techniques for tibial plateau fractures lacks a unified standard.

OBJECTIVE: To study the navigation method and effect of 64-slice CT reconstruction in tibial plateau fractures.

METHODS: A total of 44 patients with tibial plateau fractures were enrolled in this study, including 27 males and 17 females, at the age between 21 and 74 years old. These patients were randomly divided into two groups (n=22). The control group underwent navigation method according to physician’s experience. The test group underwent navigation method according to 64-slice spiral CT scan results. Healing time, full weight-bearing time, knee motion range at 1 year postoperatively, the recovery of knee function at 1 year postoperatively and adverse reaction were compared between the two groups.

RESULTS AND CONCLUSION: (1) No significant differences in full weight-bearing time and knee motion range at 1 year postoperatively were detected between the two groups (P > 0.05). Healing time was significantly shorter in the test group than in the control group (P < 0.05). (2) The excellent and good rate of knee joint was 100% at 1 year postoperatively in the test group, which was significantly higher than the control group (81%) (P < 0.05). (3) The complication rate was significantly lower in the test group (8%) than in the control group (18%) (P < 0.05). (4) These results indicate that the effect of 64-slice CT reconstruction for navigation in tibial plateau fractures was ideal, could clearly simulate the pedicle screw fixation channel, visibly display anatomic characteristics of tibial plateau fractures, improve internal fixation accuracy, and improve repair effect.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tibial Fractures, Intra-Articular Fractures, Cicatrix, Hypertrophic, Tissue Engineering

CLC Number:

R318

Xu Hong-wei. Navigation method of 64-slice CT reconstruction in tibial plateau fractures[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(26): 3923-3928.

Figures/Tables 2

References

[1] 王发成,曹海念,许忠曦.64排螺旋CT三维重建与X线平片在胫骨平台骨折诊断中的对比[J].中国中医药现代远程教育, 2010,8(2):139-141.
[2] Baumann P,Ebneter L,Giesinger K,et al.A triangular support screw improves stability for lateral locking plates in proximaltibial fractures with metaphyseal comminution: a biomechanical analysis.Arch Orthop Trauma Surg.2011;131(6):815-821.
[3] 戴志龙,芦中庆,侯建明,等.多层螺旋CT后处理技术对胫骨平台隐匿性骨折的诊断价值[J].临床军医杂志, 2010, 38(5):807-909.
[4] 杜国生,华亮,薛源,等.术前CT扫描三维重建对胫骨平台骨折手术方式和内固定选择的评价[J].中国医药指南, 2011,9(21):34-36.
[5] 洪敏昌,张文英,周应平.多层螺旋CT二维三维重建技术在骨关节骨折中的应用[J].实用医学影像杂志,2011,12(2): 102-103.
[6] Vendeuvre T,Babusiaux D,Breque C,et al.Tuberoplasty: Minimally invasive osteosynthesis technique for tibial plateau fractures.Orthop Traumatol Surg Res.2013; 99(4 Suppl):S267-272.
[7] 丁燕萍,杨莹.64 排螺旋CT三维重建在胫骨平台骨折修复中的价值[J].中国组织工程研究,2015,19(4):612-617.
[8] 丁勇明,陶振东,巢玉柳.CT三维重建技术在胫骨平台骨折中的临床应用[J].临床医学工程,2013,20(9):1069-1070.
[9] 王小进,白卓杰,张本善,等.16层螺旋CT三维重建在诊断胫骨平台骨折中的价值[J].中外医疗,2012,31(33): 168-169.
[10] 林义才,赵劲民,花奇凯,等.三柱分型指导治疗胫骨平台骨折疗效分析[J].广西医科大学学报,2012,29(2):272-274.
[11] Siegler J,Galissier B,Marcheix PS,et al.Percutaneous fixation of tibial plateau fractures under arthroscopy: a medium term perspective.Orthop Traumatol Surg Res. 2011;97(1):44-50.
[12] 方挺松,柯祺,黄钰坚,等.胫骨平台骨折患者膝关节韧带及半月板损伤的多层螺旋CT诊断[J].现代医用影像学,2014, 19(2):96-99.
[13] 钟开祥,赵云娥.16 层螺旋CT后处理技术对外伤性胫骨平台骨折的诊断价值[J].实用医学影像杂志, 2012,13(2): 110-112.
[14] 王振强,闫呈新,张玉敏.128层螺旋CT的MRP和VR在胫骨平台骨折中的应用[J].医学影像学杂志,2011,21(9): 1401-1403.
[15] Zhu Y,Yang G,Luo CF,et al.Computed tomography-based Three -Column Classification in tibial plateau fractures：introduction of its utility and assessment of its reproducibility.J Trauma Acute Care Surg.2012;73 (3):731-737.
[16] 中华创伤骨科杂志编辑委员会.胫骨平台骨折诊断与治疗的专家共识[J].中华创伤骨科杂志,2015,17(1):3-7.
[17] Yang G,Zhai Q,Zhu Y,et al.The incidence of posterior tibial plateau fracture:an investigation of 525 fractures by using a CT-based classification system.Arch Orthop Trauma Surg.2013;133(4):929-934.
[18] Chang SM,Zhang YQ,Yao MW,et al.Schatzker type Ⅳ medial tibial plateau fractures: a computed tomography -based morphological subclassification. Orthopedics. 2014;37(8):699-706.
[19] te Stroet MA,Holla M,Biert J.The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures.Emerga Radiol.2011;18(3):279-283.
[20] 张国强,丁尔勤.胫骨平台骨折的诊疗进展[J].中国骨与关节损伤杂志,2014,29(10):1078-1079.
[21] 左树青,丰佳萌.64排螺旋CT后处理技术在胫骨平台骨折中的应用价值[J].中国当代医药,2013,20(12):116-117.
[22] 尹虎.三维CT重建在复杂性胫骨平台骨折治疗中应用的价值[J].现代中西医结合杂志,2014,25(9):2791-2792.
[23] Wang J,Wei J,Wang M.The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture.Eur J Orthop Surg Traumatol.2015;25(5): 913-920.
[24] 易壁星,张博,蔡武,等.64层CT重建技术在胫骨平台骨折诊疗中的应用价值[J].中国CT和MRI杂志,2011,9(2): 58-60.
[25] de Lima Lopes C,da Rocha Candido Filho CA,de Lima E Silva TA,et al.Importance of radiological studies by means of computed tomography for managing fractures of the tibial plateau.Rev Bras Ortop.2014; 49(6):593-601.
[26] 王志军,龚瑞,赵凯,等.16排螺旋CT对胫骨平台骨折分型的诊断价值[J].陕西医学杂志,2011,40(3):290-292.
[27] Hu YL,Ye FG,Ji AY,et al.Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury.2009;40(2):1282-1285.
[28] Dodd A,Oddone Paolucci E,Korley R.The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures：a case control series.BMC Musculoskelet Disord.2015;16(6):144-149.
[29] 谢卫宁,杨英年,李华,等.AO/OTA及三柱分型联合应用指导治疗累及后柱的胫骨平台骨折[J].中国骨与关节损伤杂志,2014,29(10):1052-1053.
[30] Patange Subba Rao SP,Lewis J,Haddad Z,et al. Three-column classification and Schatzker classification: a three-and two-dimensional computed tomography characterization and analysis of tibial plateau fractures.Eur J Orthop Surg Traumatol. 2014; 24(7):1263-1270.
[31] Chen XH,Wu XW,Lin HB,et al.Three-dimensional reconstruction reduction and design of digital plates for proximal tibia fracture. Zhongguo Zuzhi Gongcheng Yanjiu.2015;19(26):4235-4241.
[32] 郑晓晖,张国栋,黄华军,等.基于三维编辑的四肢骨折快速虚拟复位[J].中华临床医师杂志(电子版),2015,4(9):617-622.
[33] 张国栋,林海滨,陈宣煌,等.基于多平面三维测量的髋臼骨折数字化内固定植入方案[J].中华临床医师杂志:电子版, 2012,6(80:2010-2015.
[34] 蔡伟斌,胡鸿璇,郭新辉.锁定加压钢板与解剖钢板置入内固定治疗复杂胫骨平台骨折[J].中国组织工程研究, 2012, 16(52):9750-9755.
[35] 刘俊,刘锦波,王生介,等.双钢板治疗胫骨平台粉碎性骨折的临床研究[J].实用临床用药杂志,2014,18(7):129-131.
[36] Kantelhardt SR,Martinez R,Baerwinkel S,et al. Perioperative course and accuracy of screw positioning in conventional，open robotic-guided and percutaneous robotic-guided，pedicle screw placement. Eur Spine J.2011;20(6):860-868.
[37] 田伟,郎昭,刘亚军,等.术中即时三维导航辅助下轴性旋转腰椎椎弓根螺钉置入的实验研究[J].中华外科杂志, 2010, 48(11):838-841.
[38] Chen C,Ruan D,Wu C,et al.CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae.PLoS One.2013; 8(12):e81159.
[39] 陈宣煌,张国栋,吴长福,等.数字化颈前路螺钉内固定方案设计:Ⅱ型齿状突骨折的临床应用[J].中国组织工程研究, 2013,17(26):4926-4933.
[40] Tabaraee E,Gibson AG,Karahalios DG,et al. Intraoperative cone beam-computed tomography with navigation (O-ARM) versus conventional fluoroscopy (C-ARM): a cadaveric study comparing accuracy，efficiency，and safety for spinal instrumentation. Spine (Phila Pa 1976).2013;38(22):1953-1958.