16层螺旋CT三维重建成像技术在骨盆骨折中的临床意义

目的:探讨16层螺旋CT三维重建成像技术在骨盆骨折中的临床意义.方法:选取2011年8月～2012年8月我院收治的骨盆外伤患者共60例,比较CT、DR片2种检查方法.结果:16层螺旋CT片检查出53处阳性,而DR片查出43处阳性及1例假阳性.2种检查方法比较:敏感度差异存在统计学意义(P＜0.05).结论:16层螺旋CT三维重建成像技术在骨盆外伤的诊断上有着显著的优势,综合使用VRT、SSD、CPR、MPR技术,能够检测出DR片不易发现的骨折,提高了诊断符合率,对骨盆骨折的诊断有着重要的临床意义.     

螺旋CT扫描及三维重建技术在股骨颈骨折分型及治疗中的应用

目的:探讨螺旋CT扫描及三维重建技术在股骨颈骨折分型及治疗中的应用价值。方法:选择2010年5月~2013年5月期间我院收治的股骨颈骨折患者237例为研究对象,根据患者扫描检查方式的不同将其分为对照组(112例)和观察组(125例),对照组患者行髋关节X线正位扫描,观察组行髋关节正位64排螺旋CT扫描,两组均根据扫描结果进行分型并制定相应的治疗方案,比较两组患者骨折内固定手术后2年的股骨头坏死率及骨折不愈合率。结果:两组行骨折内固定手术比例比较,差异无统计学意义(P0.05);术后2年,对照组股骨头坏死5例(22.73%),骨不连6例(27.27%);观察组股骨头坏死1例(3.70%),骨不连1例(3.70%),观察组患者股骨头坏死率及骨折不愈合率均显著低于对照组,差异均有统计学意义(P0.05)。结论:螺旋CT扫描及三维重建成像能够全面、准确显示股骨颈骨折的损伤情况,有助于骨折的正确分型和治疗方法的选择,改善预后。     

多排螺旋CT扫描对骨折的诊断

目的: 普通X线片及CT平扫对于骨折,尤其是隐匿性骨折检出率较低,较易造成漏诊和误诊,随着多排螺旋CT的普及,利用曲面重建(MPR)和容积再现(VR)技术后处理图像,成为诊断隐匿性骨折的理想的影像诊断手段.探讨多排螺旋CT在对骨折的诊断中的临床应用价值。方法: 对213例临床怀疑骨折的患者进行CR摄片再进行多排螺旋CT扫描,通过三维重建技术处理后,得到受检部位二维、三维的图像。结果: 相同的对照组经多排螺旋CT、X线检查检查后,新增33例骨折。结论: 多排螺旋CT扫描及三维重建技术较传统X线平片能对骨折病例做出更正确的诊断。     

20例胫骨平台骨折治疗体会

目的:研究探讨20例胫骨平台骨折的治疗,观察其术后临床效果。方法:按照Seheazker骨折分型对20例胫骨平台骨折进行分型,有针对性地实施手术方法。结果:术后随访17例患者,随访时间6-18年,平均10.5个月。18例患者中12至18周后均骨性愈合,根据Rasmussen膝关节功能评定标准后恢复情况:12例优秀,3例良好,情况可3例,恢复差0例,总的优良率达83.3%。结论:本研究对20例胫骨平台手术治后,效果确切,值得进一步研究探讨。     

复杂胫骨平台骨折18例治疗方法探讨

目的探讨复杂胫骨平台骨折的治疗方法和临床疗效。方法自2006年1月至2008年6月,笔者对复杂胫骨平台骨折进行了手术治疗并获随访的病例共18例,所有病例术前均予X线、CT、MRI检查,并按Schatzker分型：IV型IO例,V型12例,VI型6例。结果平均随访8个半月,均获骨性愈合,无螺钉松动、断裂。根据Merchant标准综合评分：优12例,良4例,可2例。优良率83.3%。结论在良好复位,有效稳固的支撑固定下早期功能锻炼,不仅有利于骨折愈合,还对关节功能的最大恢复起着重要作用。     

切开复位内固定治疗高能量胫骨平台骨折

目的：探讨高能量胫骨平台骨折的治疗方法。方法：回顾性分析我院自1996年1月-2002年12月收治高能量伤所致胫骨平台骨折患者38例．骨折按Schatzker分类：Ⅳ型骨折11例;V型骨折18例;Ⅵ型骨折9例,均采用了切开复位,T型和L型钢板固定治疗。结果：35例获得随访,平均随访4．5月(6—29月)。功能评价采用Mechant评分标准,优良率为80％。结论：手术治疗高能量胫骨平台骨折必须着重于早期正确处理软组织损伤、骨折的解剖复位、坚强的内固定。     

锁定钢板治疗胫骨平台骨折的临床疗效分析

目的:探讨锁定钢板内固定治疗胫骨平台骨折的临床疗效及安全性。方法:回顾性分析本院2010年1月~2013年1月接受锁定钢板内固定治疗的50例胫骨平台骨折手术后患者的临床资料。其中男性36例,女性14例,骨折类型按Schatzker分型分为Ⅱ型20例、Ⅲ型6例、Ⅳ型5例、Ⅴ型7例、Ⅵ型12例,均采用开放复位锁定钢板螺钉内固定治疗。采用Rasmussen膝关节功能分级系统评价其临床疗效。结果:本组50例患者均获得随访,平均随访时间18个月(8~36个月),Rasmussen膝关节功能分级结果为:优38例,良9例,可2例,差1例,优良率达94%。结论:开放复位锁定钢板内固定治疗胫骨平台骨折具有固定可靠,骨折愈合率高的优点,且并发症少,是一种治疗胫骨平台骨折的有效内固定方法。     

64排螺旋CT对粗隆间骨折Evans分型的影响研究

目的:探讨64排螺旋CT对粗隆间骨折Evans分型的影响,为临床使用提供参考依据。方法:2015年3月至2017年3月,三甲医院高年资创伤骨科主任医师2名,医师1、医师2分别按照术前X线、术前64排螺旋CT平扫和三位重建结果对128例新鲜闭合单侧粗隆间骨折患者进行Evans分型,分别记为X线分型、CT分型。本院术者依据围术期X线、CT及术中所见骨折情况进行Evans分型(逆粗隆间骨折定义为Ⅴ型)作为最终分型。记录分型结果,计算并对比准确率、误诊率。结果:(1)剔除5例,90.09%(123/128)的患者完成研究。(2)分型结果:X线分型中,3例(最终分型Ⅲ型2例,Ⅳ型1例)无法定型;Ⅰ型正确1例,改为Ⅱ型1例;Ⅱ型正确18例,改为Ⅰ型2例,改为Ⅲ型3例,Ⅳ型2例;Ⅲ型正确45例,改为Ⅱ型7例,改为Ⅳ型1例;Ⅳ型正确19例,改为Ⅱ型3例,改为Ⅲ型15例。CT分型中,Ⅰ型正确3例,Ⅱ型正确29例,Ⅲ型正确64例,改为Ⅳ型1例,Ⅳ型正确22例,Ⅴ型正确3例。(3)CT分型的总准确率、总误诊率优于X线分型(99.19%vs67.48%、0.81%vs30.08%,P0.05)。(4)Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型骨折进行CT分型,准确率高于X线分型(P0.05),误诊率低于X线分型(P0.05);Ⅴ型骨折,两种分型准确率、误诊率相等。结论:64排螺旋CT平扫及三维重建是粗隆间骨折Evans分型较为可靠的辅助检查,可考虑推广运用。     

多排螺旋CT后处理技术对不规则骨骨折的诊断价值

目的:探讨多排螺旋CT及其后处理技术在诊断不规则骨骨折中的诊断价值。方法:用16排螺旋CT对25例怀疑颅骨、脊柱或关节附近骨折的外伤患儿进行扫描并进行后处理(MPR、VR)。结果:25例病例中颅骨骨折15例,脊柱骨折5例,四肢关节骨折5例(其中3例关节内骨折伴有骺软骨损伤)。结论:对于不规则骨骨折,多排螺旋CT及其后处理重建具有很大的优越性,应横断位、MPR及VR三者相结合判断,为临床提供丰富的、科学的、准确的信息依据。     

个性化后侧入路治疗胫骨平台后髁冠状面骨折

目的:探讨个性化后侧入路治疗单纯性胫骨平台后髁冠状面骨折手术方法。方法:12例单纯性胫骨平台后髁冠状面骨折的患者,采用后内侧或后外侧以及后内后外联合入路切开复位内固定治疗。结果:12例均获随访,随访时间8-24个月,平均13个月。患者膝关节功能评定按Hohl评分标准:优10例,良2例。复查X线片:骨折复位良好,关节面未见明显塌陷。结论:个性化后侧入路治疗单纯性胫骨平台后髁骨折冠状面可直视下暴露胫骨平台后髁,提供了更广阔的操作空间,有利于骨折的解剖复位内固定。     

Upregulation of microRNA-9-5p inhibits apoptosis of chondrocytes through downregulating Tnc in mice with osteoarthritis following tibial plateau fracture

Osteoarthritis (OA) is a common degenerative joint disease which is typically progressed with age, affecting smaller joints of hands, lower limbs, and the vertebral column. It has been reported that microRNAs could regulate the biological processes of OA. Therefore, the purpose of this study was to elucidate miR-9-5p's role in regulating cartilage remodeling of OA mice following tibial plateau fracture (TPF) through regulation of tenascin C (Tnc). Initially, we determined the expression of miR-9-5p and Tnc in mice with OA and then testified their relationship. The results displayed a high expression of Tnc, but a poor expression of miR-9-5p with high methylation in OA. Tnc was confirmed to be a target gene of miR-9-5p. Moreover, based on gain- and loss-function experiments, an increase of miR-9-5p and loss of Tnc had the potential to inhibit cell apoptosis, while facilitating cell proliferation, migration, invasion, and cartilage remodeling of mice with OA following TPF. This was further demonstrated by a higher expression of type II collagen, lower type X collagen, and protogenin expression. Subsequently, downregulation of miR-9-5p aggravated the pathological changes of mice, illustrated by an increase in the Mankin score. In conclusion, the present study proved that overexpression of miR-9-5p suppressed chondrocytes apoptosis and promoted cartilage remodeling through downregulating of Tnc in mice with OA.     

Virtual structural analysis of tibial fracture healing from low-dose clinical CT scans

Quantitative assessment of bone fracture healing remains a significant challenge in orthopaedic trauma research. Accordingly, we developed a new technique for assessing bone healing using virtual mechano-structural analysis of computed tomography (CT) scans. CT scans from 19 fractured human tibiae at 12 weeks after surgery were segmented and prepared for finite element analysis (FEA). Boundary conditions were applied to the models to simulate a torsion test that is commonly used to access the structural integrity of long bones in animal models of fracture healing. The output of each model was the virtual torsional rigidity (VTR) of the healing zone, normalized to the torsional rigidity of each patient’s virtually reconstructed tibia. This provided a structural measure to track the percentage of healing each patient had undergone. Callus morphometric measurements were also collected from the CT scans. Results showed that at 12 weeks post-op, more than 75% of patients achieved a normalized VTR (torsional rigidity relative to uninjured bone) of 85% or above. The predicted intact torsional rigidities compared well with published cadaveric data. Across all patients, callus volume and density were weakly and non-significantly correlated with normalized VTR and time to clinical union. Conversely, normalized VTR was significantly correlated with time to union (R² = 0.383, p = 0.005). This suggests that fracture scoring methods based on the visual appearance of callus may not accurately predict mechanical integrity. The image-based structural analysis presented here may be a useful technique for assessment of bone healing in orthopaedic trauma research.     

CT影像和X线平片在脊柱爆裂型骨折诊断中的对比分析

目的分析X线平片与CT影像在脊柱爆裂骨折诊断中的应用价值。方法选取2015年7月~2016年7月我院收治的脊柱爆裂骨折患者70例为研究对象,按随机数字表法分为对照组和观察组,对照组患者予以X线平片进行诊断,观察组患者予以CT影像进行诊断,对比分析两组患者的检出率、检出时间以及检查费用情况。结果对照组患者的检出率为65.71%,检出时间(9.21±0.13)min,检查费用(115±25.20)元;观察组患者的检出率为88.57%,检出时间(2.32±0.30)min,检查费用(628±52.6)元。两组比较差异均有统计学意义(均P0.05)。结论脊柱爆裂型骨折患者行CT影像学诊断的临床价值明显优于X线平片,值得作为脊柱爆裂型骨折的首选检查方法。     

16层螺旋CT三维重建与DR平片检查对外伤性肋骨骨折的诊断价值比较研究

目的:研究16层螺旋电子计算机断层扫描(CT)三维重建与数字化摄影(DR)平片检查对外伤性肋骨骨折的诊断价值,为临床诊治提供参考。方法:将2017年6月至2018年6月期间于本院接受诊治的82例外伤性肋骨骨折患者作为研究对象,所有患者均接受16层螺旋CT三维重建与DR平片检查,观察并记录患者的骨折发生部位,并比较两种诊断方法对外伤性肋骨骨折诊断的准确率、灵敏度、特异性、阳性预测值、阴性预测值以及漏诊情况。结果:82例外伤性肋骨骨折患者经影像学与临床诊断明确发生骨折179处,多发性骨折发生率为62.20%,单发性骨折发生率为37.80%,骨折肋骨段位中4-10段骨折发生率最高为69.83%,骨折肋骨水平阶段中腋肋骨折发生率最高为59.78%。相较于DR平片,16层螺旋CT三维重建诊断外伤性肋骨骨折的准确率、灵敏度、特异性、阳性预测值、阴性预测值更高,漏诊率更低,差异有统计学意义(P0.05)。结论:相较于DR平片检查,应用16层螺旋CT三维重建检查外伤性肋骨骨折能明显提高临床诊断的准确率、灵敏度和特异性,减少漏诊,可为临床诊治提供更可靠的信息,值得临床推广。     

CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用

摘要 目的：探讨电子计算机断层扫描(Computed Tomography,CT)与磁共振成像(Magnetic resonance imaging,MRI)扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用。方法：2016年9月到2019年10月选择在本院诊治的下拟诊为四肢骨关节隐匿性骨折118例,所有患者都给予CT与MRI扫描三维重建诊断,记录影像学特征与判断诊断价值。结果：在118例患者中,最终确诊为四肢骨关节隐匿性骨折98例,无骨折20例,其中腕关节骨折34例,踝关节骨折22例,膝关节骨折15例,肘关节骨折15例,肩关节骨折8例,髋关节骨折4例。在98例确诊的四肢骨关节隐匿性骨折中,MRI三维重建显示双边征、骨质破坏、充气征、软组织影等比例显著都高于CT (P<0.05)。CT与MRI三维重建诊断四肢骨关节隐匿性骨折的敏感性为89.8 %和99.0 %,特异性为95.0 %和100.0 %,误诊率分别为9.3 %和0.8 %,MRI三维重建诊断的敏感性高于CT ,漏诊率低于CT。结论：CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用都有很好的价值,特别是MRI三维重建能清晰显示骨折特征,具有更高的诊断敏感性,能减少漏诊率,可作为四肢骨关节隐匿性骨折的首选检查方法。     

膝关节镜微创手术治疗胫骨内侧平台骨折的临床研究

目的:探讨膝关节镜辅助下采用微创手术治疗老年胫内平台骨折的临床疗效及安全性。方法:按照随机数字表法将2012年1月~2014年1月我院骨科收治的老年胫骨内侧平台骨折患者分为两组,治疗组行膝关节镜辅助下微创手术治疗,对照组行常规手术固定治疗,比较两组的临床疗效及安全性。结果:治疗组的手术时间、术中出血量、术后引流量及住院时间均小于对照组,差异有统计学意义(P0.05);治疗组的HSS评分优于对照组,差异有统计学意义(Z=2.015,P=0.044);两组术后并发症主要有伤口化脓、骨折畸形、膝关节僵直、创伤性关节炎以及伤口软组织不同程度的感染,治疗组发生率16.67%,对照组40.00%,两组差异有统计学意义(P0.05)。结论:老年胫骨内侧平台骨折在膝关节镜辅助下采用微创手术治疗能够有效减轻患者疾病负担,且具有临床疗效好、安全性高等特点,临床有重要参考价值。     

The use of deep frozen and irradiated bone allografts in the reconstruction of tibial plateau fractures

To investigate the clinical behavior of deep frozen and irradiated bone allografts in the treatment of depressed tibial plateau fractures. Twenty-two patients with a tibial plateau fracture were treated with cancellous bone allografts. The bone allograft preparation process included fresh-freezing at ?70 °C for 4 weeks and gamma-irradiation at 25 kGy. All of the patients were followed for 1–2 years. The clinical effects were assessed using the Rasmussen score for tibial head fractures and X-rays. Postoperatively, the average excellent and fair Rasmussen scores were 88.9 %. Only one patient developed an infection, with no integration between allograft and recipient bone observed. All of the other bone allografts were incorporated successfully, and no osteoporosis or sclerosis was observed. The frozen and gamma-irradiated bone allograft is a good alternative in the treatment of tibial plateau fractures, which we have shown can integrate with the surrounding host bone.     

Three-dimensional reconstruction of the 30 S ribosomal subunit from randomly oriented particles

Electron micrographs show the small (30 S) subunit of Escherichia coli ribosomes lying in a wide range of positions on the specimen support, related by rotation principally around the long axis of the particle. Through correspondence analysis, a multivariate statistical method that distinguishes the major factors accounting for interimage variance, the (aligned) views of the randomly oriented particles were ordered and grouped according to tilt angle. Views so grouped were then averaged and used as input to a three-dimensional reconstruction program.The particle reconstructed from nine averaged projections spanning a 160 ° rotational range has a resolution of 5 nm in planes perpendicular to the long axis of the particle and ~ 3 nm in the direction of the long axis. It is somewhat asymmetrical and quite compact; its most conspicuous feature is the “platform” that wraps partially around the middle of the subunit.