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Diagnostic Value of MSCT in the Tibial Plateau Fractures

Author: ZhangZhaoLin
Tutor: LiChangQin
School: Taishan Medical College
Course: Medical Imaging and Nuclear Medicine
Keywords: tibial plateau fracture multi-slice spiral CT multiplanarreconstruction 3D reconstruction
CLC: R816.8
Type: Master's thesis
Year: 2013
Downloads: 23
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ObjectiveTo study the effection of computed tomography(CT) and post-processingtechniques in diagnosis and Schatzker classification of tibial plateau fractures, andcontrast and analyse the diagnostic value of tibial plateau fractures amongX-ray, spiral ct, MPR and VR postprocessing techniques so as to provide morereliable, intuitive evidence for clinical treatment.Materials and Methods211cases of tibial plateau fractures which have been confirmed by operation andwere treated in Affiliated Hospital of Taishan Medical College from February2010toFebruary2013were collected.There were126males and85females.Their averageage was40years with a span from11to77years. Eighty-one fractures were on theright side,and one hundred and twenty-nine the left side. One of these cases wasbilateral tibial plateau fractures. All of cases were examined preoperatively under CTscans, MPR and VR postprocessing techniques of knee joint except for one patientwho only examined under X-ray because he was seriously injured so that he couldn’tbe changed his position. Two high qualification radiologists were separately asked togroup the images of tibial plateau fractures of different imaging tests according toSchatzker system and contrast the results so as to analyse the value of X-ray, spiral ct,MPR and VR postprocessing techniques in the diagnosis of tibial plateau fractures.ResultsThe number of the side of the correct classification of the Schatzker system is169on X-ray films, including19sides belong to the type Ⅰ,31sides belong to thetype Ⅱ,13sides belong to the type Ⅲ,27sides belong to the type Ⅳ,52sides belongto the type Ⅴ,27sides belong to the type Ⅵ.The number of the side of the correctclassification of the Schatzker system is205sides on CT films, including31sides are part of the type Ⅰ,41sides are part of the type Ⅱ,22sides are part of the type Ⅲ,32sides are part of the type Ⅳ,52sides are part of the type Ⅴ,27sides are part of thetype Ⅵ.The diagnostic accuracy were79.7%and96.7%according to the results afteroperation. Compared with X-ray and CT,χ2=25.338,P<0.01,has significant deviation.So we know that the accuracy of the multi-slice spiral CT is higher than the X-rayfilms. The accuracy of the classification of the type Ⅰ is9.0%on X-ray films and14.6%on CT films. Compared with X-ray and CT, P=0.001,P<0.01,has significantdeviation. The accuracy of the classification of the type Ⅱis14.6%and19.3%.Compared with them, P=0.001,P<0.01,has significant deviation. The accuracy of theclassification of the type Ⅲ is6.1%and10.4%.Compared with them, P=0.005,P<0.01,has significant deviation. The accuracy of the classification of the type Ⅳis12.7%and15.1%. Compared with them, P=0.020,P<0.01,has significant deviation.There are no difference between X-ray and CT when we classify these fractures intothe type Ⅴ and type Ⅵ. So thesensitivity of the type Ⅰ, Ⅲ and Ⅳ ofthe Schatzkerclassification of tibial plateau fractures are higher than others and have obviousadvantages. Compared with the difference of the intercondylar eminence among thetype Ⅰ, Ⅱ, Ⅲ and Ⅳ andthe difference of the caput fibulae fractures among thesetypes, P<0.001, have significant deviation.ConclusionThe x-ray is the initial method in diagnosing the tibial plateau fracture because itis cheap and convenient. It can show the general situation of the fractures of the tibialplateau and diagnose most of the tibial plateau fractures.But it couldn’t provideperfect information for clinical treatment. It need the help of other imaging methods,such as the multi-slice spiral CT, because the fracture of tibial plateau is very complex.Plain CT scans and reconstruction technology could display the tibial plateaufractures completely and comprehensively and stereoscopically, it would be better forcorrectlly grouping of Schatzker of tibial plateau fractures. It could avoid misseddiagnosis effectively such as the fractures of caput fibulae and intercondylar eminencewhich x-ray plain film couldn’t display. It can provide evidence for making suitableclinical treatment plan and reviewing after treatment.

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CLC: > Medicine, health > Of Medical > Radiation Medicine > Each location and course of disease X - ray diagnosis and therapy > Surgery, orthopedics
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