Three-dimensional image reconstruction for elbow fractures

doi:10.3969/j.issn.2095-4344.2013.13.021

Abstract

Abstract:

BACKGROUND: The structure and function of elbow joint is complex, which has an important role in adjusting the upper limb activities.
OBJECTIVE: To evaluate the diagnostic effect of different imaging methods on elbow fracture.
METHODS: The diagnostic effects of X-ray image, CT image and MRI image on internal and external humeral condyle fracture, humeral supracondylar and intercondylar fractures, radial head fractures and ulna coronoid fractures, as well as the injury of surrounding ligaments, tendons and other soft tissues were evaluated, especially the imaging evaluation of the commonly seen “terrible triad” of elbow trauma was performed.
RESULTS AND CONCLUSION: X-ray could clearly display the fracture line of elbow fracture and the displacement of fracture site, and it could be able to show the position of posterior triangle of elbow joint. CT scanning has better detection effect on fracture than X-ray image. It cannot only display the displaced fracture, micro-displaced fracture and tiny intra-articular fracture fragments, but also display the position, area, number, size, displacement and crushing circumstances of fracture. MRI is mainly used to evaluate surrounding tissue injury of the elbow joint.

Key words: bone and joint implants, academic discussion of bone and joint implants, elbow joint, fracture, X-ray, computed tomography, magnetic resonance imaging, terrible triad, internal humeral condyle, external humeral condyle, radial head, ulnar coronoid, ligament, tendon, photographs-containing paper of bone and joint image

CLC Number:

R318

Lu Hao-ning, Pan Shi-nong. Three-dimensional image reconstruction for elbow fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2431-2438.

Figures/Tables 7

影像学诊断：右肘关节恐怖三联征，右肘关节后脱位合并右桡骨小头粉碎性骨折(MasonⅢ型)以及右尺骨冠突粉碎性骨折(Regan-MorreyⅢ型)。行“右肘关节骨折切开复位内固定”，内固定操作中发现桡骨小头粉碎骨折，桡骨颈处骨质压缩，冠状突粉碎骨折。复位冠状突，复位桡骨小头，修复肘关节外侧韧带。肘关节“恐怖三联征”是Hotchkiss[15]于1996年首次命名，即肘关节后脱位同时伴有尺骨冠突骨折和挠骨头骨折。由于肘关节“恐怖三联征”属于复杂不稳定、高能量的肘部创伤，临床治疗较为困难，由此引起的关节不稳定、创伤性关节炎及关节僵硬、异位骨化等并发症常导致患者预后不良。 Ring等[16]和Pugh等[17]进一步对此类损伤进行了研究与报道。“恐怖三联征”多见于坠落伤及车祸，是肘部严重的高能量创伤。最常见的损伤机制为肘关节在伸直位，遭受纵轴方向的高能量压缩剪切暴力造成[18]。主要损伤包括肘关节后脱位，桡骨头骨折，冠突骨折，双侧副韧带撕裂，前关节囊撕裂等。目前认为尺骨冠突和内外侧副韧带是肘关节稳定的第一列因素，桡骨头、关节囊和屈肌、伸肌起点是第二列因素[19]。因此，肘关节“恐怖三联征”的尺骨冠突及桡骨头骨折以及侧副韧带损伤能够导致肘关节极度不稳定。临床常用Regan-Morrey分类法评价冠突骨折：冠突尖部骨折为Ⅰ型，冠突骨折块高度小于冠突高度的50%为Ⅱ型，冠突骨折块高度大于或等于冠突高度的50%为Ⅲ型[20]。其中冠突高度指尺骨冠突尖至滑车最低点的垂直距离，即经鹰嘴尖作一与尺骨干平行的直线，该直线即为冠突高度50%的分界线。用Mason[21]分类法评价桡骨头骨折：桡骨头无移位性骨折为Ⅰ型，桡骨头骨折伴分离移位，但仍有部分桡骨头与骨干相连为Ⅱ型，桡骨头粉碎性骨折，头与骨干分离为Ⅲ型。之后Johnston将Mason法改良，把桡骨头骨折伴肘关节后脱位增加为第Ⅳ型，因此对于肘关节“恐怖三联征”，所有桡骨头骨折均为Johnston改良后的第Ⅳ型。文章病例右尺骨冠突骨折属于Regan-Morrey分类Ⅲ型，右桡骨头骨折属于Mason分类Ⅲ型，属于Johnston改良后的第Ⅳ型。"

References

[1] 王云钊.中华影像医学:骨肌系统卷[M].北京:人民卫生出版社, 2002:128.

[2] 陈明祥,邰学祥,陈娟,等.螺旋CT多平面和三维重建在肘关节骨折中的诊断价值[J].实用放射学杂志,2007,23(5):656-657.

[3] 李德龙,刘斯平,王振波.16层MSCT不同重建方法在骨与关节疾病诊断中的应用价值研究[J].中国中西医结合影像学杂志,2007, 5(2):106-109.

[4] Mulkens TH, Bellinck P, Baeyaert M, et al. Use of an automatic exposure control mechanism for dose optimization in multi-detector row CT examinations: clinical evaluation. Radiology. 2005;237(1):213-223.

[5] van Riet RP, Bain GI, Baird R, et al. Simultaneous reconstruction of medial and lateral elbow ligaments for instability using a circumferential graft. Tech Hand Up Extrem Surg. 2006;10(4):239-244.

[6] Haapamäki VV, Kiuru MJ, Mustonen AO, et al. Multidetector computed tomography in acute joint fractures. Acta Radiol. 2005;46(6):587-598.

[7] Wodecki P, Maiza D, Rozenblum B. Elbow dislocation in children associated with proximal radioulnar translocation. Rev Chir Orthop Reparatrice Appar Mot. 2007;93(2):190-194.

[8] 扈延龄,裴国献,李旭,等.三维CT重建对关节内骨折分型术前评价的影响[J].中国矫形外科杂志,2008,16(8):568-570.

[9] 何强.MSCT重建技术在肘关节创伤性骨折中的应用[J].实用临床医药杂志,2012,16(13):65-66.

[10] 栗占国.类风湿关节炎[M].北京:人民卫生出版社,2009:149.

[11] 中国知网.中国学术期刊总库[DB/OL].2013-1-10. https://www.cnki.net

[12] 肖观东,周长元,郑超,等.肘关节骨折56例数字化X线摄影分析[J].广东医学,2011,32(6):780-782.

[13] 龙响云,方向军,罗祖孝,等.16层螺旋CT多平面重组和容积再现对肘关节损伤的诊断价值[J].重庆医科大学学报,2011,36(8): 985-987.

[14] 梁秀梅.MRI对22例肘关节病变的诊断价值[J].重庆医学,2012, 41(10):993-996.

[15] Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA, Green DP, Bucholz RW, et al. Rockwood and Green's fractures in adults. 4th ed.Volume 1. Philadelphia: Lippincott-Raven,1996:929-1024.

[16] Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. 2002;84-A(4):547-551.

[17] Pugh DM, McKee MD. The "terrible triad" of the elbow. Tech Hand Up Extrem Surg. 2002;6(1):21-29.

[18] Amis AA, Miller JH. The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury. 1995;26(3): 163-168.

[19] 张世民.肘关节恐怖三联征的诊治进展[J].同济大学学报(医学版),2010,31(1):5-11.

[20] Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am. 1989;71(9):1348-1354.

[21] Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954; 42(172):123-132.

[22] Durakbasa MO, Gumussuyu G, Gungor M, et al. Distal humeral coronal plane fractures: management, complications and outcome. J Shoulder Elbow Surg. 2013;22(4):560-566.

[23] Riseborough EJ, Radin EL. Intercondylar T fractures of the humerus in the adult. A comparison of operative and non-operative treatment in twenty-nine cases. J Bone Joint Surg Am. 1969;51(1):130-141.

[24] Wong AS, Baratz ME. Elbow fractures: distal humerus. J Hand Surg Am. 2009;34(1):176-190.

[25] Lumsdaine W, Enninghorst N, Hardy BM, et al. Patterns of CT use and surgical intervention in upper limb periarticular fractures at a level-1 trauma centre. Injury. 2013;44(4): 471-474.

[26] McCollough CH, Primak AN, Saba O, et al. Dose performance of a 64-channel dual-source CT scanner. Radiology. 2007;243(3):775-784.

[27] Cody DD, Stevens DM, Ginsberg LE. Multi-detector row CT artifacts that mimic disease. Radiology. 2005;236(3):756-761.

[28] 王土兴,王立章,俞方荣.多层螺旋CT在骨创伤诊断中的临床价值[J].中国医学影像技术,2003,19(1):118-119.

[29] Jelly LM, Evans DR, Easty MJ, et al. Radiography versus spiral CT in the evaluation of cervicothoracic junction injuries in polytrauma patients who have undergone intubation. Radiographics. 2000;20 Spec No:S251-9; discussion S260-262.

[30] Klingebiel R, Kentenich M, Bauknecht HC, et al. Comparative evaluation of 64-slice CT angiography and digital subtraction angiography in assessing the cervicocranial vasculature. Vasc Health Risk Manag. 2008;4(4):901-907.

[31] Guitton TG, Ring D; Science of Variation Group. Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensionalCT. J Bone Joint Surg Am. 2011;93(21):2015-2021.

[32] Adams JE, Sanchez-Sotelo J, Kallina CF 4th, et al. Fractures of the coronoid: morphology based upon computer tomography scanning. J Shoulder Elbow Surg. 2012;21(6): 782-788.

[33] Kotsianos D, Rock C, Euler E, et al. 3-D imaging with a mobile surgical image enhancement equipment (ISO-C-3D). Initial examples of fracturediagnosis of peripheral joints in comparison with spiral CT and conventional radiography. Unfallchirurg. 2001;104(9):834-838.

[34] Rieker O, Mildenberger P, Rudig L, et al. 3D CT of fractures: comparison of volume and surface reconstruction. Rofo. 1998;169(5):490-494.

[35] Dewailly M, Rémy-Jardin M, Duhamel A, et al. Computer- aided detection of acute pulmonary embolism with 64-slice multi-detector row computed tomography: impact of the scanning conditions and overall image quality in the detection of peripheral clots. J Comput Assist Tomogr. 2010;34(1): 23-30.

[36] Mowatt G, Cummins E, Waugh N, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess. 2008; 12(17): Iii-iv, ix-143.

[37] Gufler H, Schulze CG, Wagner S, et al. MRI for occult physeal fracture detection in children and adolescents. Acta Radiol. 2013.

[38] Rhyou IH, Kim KC, Kim KW, et al. Collateral ligament injury in the displaced radial head and neck fracture: correlation with fracture morphology and management strategy to the torn ulnar collateral ligament. J Shoulder Elbow Surg. 2013;22(2): 261-267.

[39] Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med. 1994;22(1):26-31; discussion 32.

[40] Fritz RC, Steinbach LS, Tirman PF, et al. MR imaging of the elbow. An update. Radiol Clin North Am. 1997;35(1):117-144.