Vetter Sven Yves, Euler Finn, von Recum Jan, Wendl Klaus, Grützner Paul Alfred, Franke Jochen
BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany.
BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
Foot Ankle Int. 2016 Sep;37(9):977-82. doi: 10.1177/1071100716650532. Epub 2016 May 17.
The intraoperative assessment of the articular surface in displaced intra-articular distal tibia fractures can be challenging using conventional fluoroscopy. The aim of the study was to determine the frequency and the method of intraoperative corrections of fracture reductions or implant placements during open reduction, internal fixation by using cone beam computed tomography (CT) after conventional fluoroscopy.
Displaced intra-articular distal tibia fractures were retrospectively analyzed from August 2001 until December 2011. The fractures were classified according to the standards of the AO/OTA as type B or C and treated with open reduction and internal plate fixation. After primary reduction using conventional fluoroscopy, an additional cone beam CT scan was used to determine the alignment of the joint line and the implant position. The number of intraoperative revisions of the primary reduction due to the use of cone beam CT was analyzed.
A total of 143 patients with an intra-articular tibial plafond fracture were included in the analysis. In 43 patients (30%), an intraoperative correction was performed after the cone beam CT scan. In 34 (24%) of these cases, intraoperative correction was required because of inadequate joint line reduction. Nine (6%) corrections were required as a result of a malposition of the implant. The revision rate did not differ by fracture classification.
Despite its acceptance as the standard method of imaging, intraoperative conventional fluoroscopy for the assessment of implant positioning and fracture reduction of tibial plafond fractures is limited. The intraoperative utilization of cone beam CT provided additional information for the surgeon to detect insufficient reduction or implant malposition.
Level III, retrospective comparative series.
对于移位的胫骨远端关节内骨折，使用传统的荧光透视法进行术中关节面评估具有挑战性。本研究的目的是确定在传统荧光透视后使用锥形束计算机断层扫描（CT）进行切开复位内固定期间，骨折复位或植入物放置的术中校正频率和方法。
回顾性分析2001年8月至2011年12月期间移位的胫骨远端关节内骨折。根据AO/OTA标准将骨折分类为B型或C型，并采用切开复位内钢板固定治疗。在使用传统荧光透视法进行初步复位后，使用额外的锥形束CT扫描来确定关节线的对线情况和植入物位置。分析因使用锥形束CT而对初步复位进行术中修正的次数。
共有143例胫骨平台关节内骨折患者纳入分析。43例患者（30%）在锥形束CT扫描后进行了术中校正。其中34例（24%）因关节线复位不充分而需要术中校正。9例（6%）因植入物位置不当而需要校正。校正率在骨折分类方面无差异。
尽管术中传统荧光透视法被公认为成像的标准方法，但用于评估胫骨平台骨折植入物定位和骨折复位时存在局限性。术中使用锥形束CT为外科医生提供了额外信息，以检测复位不足或植入物位置不当。
III级，回顾性比较系列研究。
