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目的探讨多层螺旋CT(MSCT)对齿状突骨折的诊断价值。方法回顾性分析24例齿状突骨折的CT轴位薄层图像表现,对在工作站获取的薄层图像分别进行多平面重建(MPR),容积再现(VR),CT仿真内窥镜(CTVE)及四维透明显示(4D-Ray-sum)4种方法重建。有5例行颈前路加压螺丝内固定治疗的病例进行术前齿状突解剖数据的测量,并对16例复查病例的CT图像进行治疗前后对比分析。结果24例齿状突骨折根据Anderson及D’Alonzo分型,Ⅰ型1例,Ⅱ型15例(其中2例合并寰椎骨折),Ⅲ型8例。24例中行Halo氏外固定架治疗16例,行颈前路加压螺丝内固定治疗5例,行颈后路椎弓根螺钉内固定治疗3例。16例治疗后复查病例中,有9例行Halo氏外固定治疗,显示齿状突骨折复位满意,骨折愈合良好;有7例行内固定治疗,显示齿状突骨折复位满意,内固定物的位置良好。结论MSCT可作为齿状突骨折诊断及治疗评价的首选检查方法。
Objective To investigate the diagnostic value of multi-slice spiral CT (MSCT) for odontoid fracture. Methods Twenty-four cases of odontoid fractures were retrospectively analyzed. The multi-planar reconstruction (MPR), volumetric reconstruction (VR), CT virtual endoscopy (CTVE) And four-dimensional transparent display (4D-Ray-sum) four methods of reconstruction. There were 5 cases of anterior cervical pedicle screw fixation for the treatment of preoperative odontoid anatomy data measurement, and 16 cases of review of CT images were compared before and after treatment. Results According to Anderson and D’Alonzo classification, 24 cases of odontoid fractures were classified as type Ⅰ in 1 case, type Ⅱ in 15 cases (2 cases with atlas fractures) and type Ⅲ in 8 cases. Twenty - four cases of Halo ’s external fixator were treated by X - ray in 16 cases. Five cases were treated by anterior cervical compression screw fixation and 3 cases were treated by posterior cervical pedicle screw fixation. Out of the 16 cases after treatment, 9 cases underwent Halo’s external fixation, which showed satisfactory reduction of odontoid fractures and good fracture healing. Seven cases underwent internal fixation, which showed satisfactory reduction of odontoid fractures, satisfactory fixation of internal fixation Good location. Conclusion MSCT can be used as the first choice for the diagnosis and treatment of odontoid fractures.