Gülden ŞAHİN, Ebru DÜŞÜNCELİ ATMANL, Çağlar UZUN

Helikal Bilgisayarlı Tomografi İle Artiküler Travmaların Değerlendirilmesinde Uç Boyutlu Görüntülemenin Tanıya Katkısı

Amaç: Çalışmanın amacı eklemle ilişkili kırık ön tanısı ile başvuran travma hastalarındaüç boyutlu (3B) bilgisayarlı tomografi (BT) görüntülemenin, aksiyel BT'ye ilave tanısal bilgi sağlayıp sağlamadığını ortaya koymaktır. Gereç ve yöntem: Acil servis ve ortopedi klinikleri tarafından ardışık olarak refere edilen 34 olgu (ortalama 45 9.1 yaş, E/K 21/13) çalışma kapsamında prospektif olarak incelendi. On yedi diz, ayak bileği, dirsek, asetabulum, omuz, el bileği olmak üzere toplam 36 eklem kırığı değerlendirildi. Olgular fraktür hatlarının vizualizasyonu, eklem yüzeylerine uzanım, eklem içi fragman varlığı ve yerdeğiştirme açısından direkt grafi, aksiyel, multiplanar reformat (MPR) ve 3B BT görüntüleri ile değerlendirildi. Bulgular: Aksiyel BT ile saptanan toplam 36 fraktür bölgesinin 35'inde (%97.2) fraktür hattı, artiküler uzanım ve eklem içi kemik fragman 3B BT ile görüntülenebildi (%95 GA, %91.9-100.0). Bir bölgede (%2.78) tanımlanan değişkenler kuşkulu olarak değerlendirildi (%95 GA, %0--8.1). Aksiyel BT ile saptanan yer değiştirme tüm bölgelerde 3B BT ile de gösterildi. Sonuç: BT incelemesi için uygun pozisyon verilebilen artiküler travma olgularında 3Bgörüntüler, aksiyel ve MPR görüntüler ile elde edilenlere ilave bilgi vermemektedir. Ancak uygun pozisyon verilemeyen veya pelvis, dirsek gibi kompleks anatomiye sahip bölgelerde kırık uzanımı, fragman deplasmanı ve açılanma yönünden 3B görüntülerin anatomikoryantasyonu sağlamadave bu karmaşıkverileri klinisyene aktarmada faydalıdır.

Evaluation ofArticular Trauma with Helical Computed Tomography:Contribution of Three—Dimensional Imaging

Objective: The purpose of this study is to evaluate the additional diagnostic value of 3D CT imaging for articular fracture in trauma patients as supplement to standart axial CT. Material and method: 34 cases referred consecutively from emergency and orthopedics clinics (average age 45 9.1 age, M/F 21/13) were prospectively examined in this study. 17 knee fractures, ankle fractures, elbow fractures, acetabulum fractures, shoulder fractures and wrist fractures, in total 36joint fractures were evaluated. The cases were evaluated with radiography, axial, multiplanar reformatted (MPR) and three dimensional (3D) CT images in terms of fractures, extension to articular surfaces, intraarticular fragments and displacement. Findings: In 35 out of 36 fracture regions detected by CT (97.2%), the fracture line, articular extension and intraarticular bone fragments could be displayed with 3D CT (95% CI, 91 .9-100.0%). Variables de- fined in one region (2.78%) were evaluated as suspicious (95% CI, 0-8.1 %). The displacement detected with axial CT was shown with 3D CT as well in all regions. Result: In articular trauma cases giving proper positions for CT examination, 3D images did not provide additional information to the information obtained by axial and MPR images. However, in terms ofthe fracture extension, fragment displacement and angulation that cannot have proper positioning or with complex anatomy such as pelvis or elbow, 3D images are beneficial in ensuring anatomic orientation and transferring these complex data to the clinician.

PDF

___

Pretorius ES, Fishman EK. Volume-ren- dered three-dimensional spiral CT: muscu- loskeletal applications. Radiographics 1999;19:1143-1160.
Magid D, Fishman EK. Imaging of mus- culoskeletal trauma in three dimensions. Radiol Clin North Am 1989;27:945-956.
Kuszyk BS, Ney DR, Fishman EK. The current state of the art in three-dimensio- nal oncologic imaging:an overview. Int J Radiat Oncol Biol Phys 1995;33:1029- 1039.
Pretorius ES, Fishman EK. Helical (spiral) CT of the musculoskeletalsystem. Radiol Clin North Am 1995;33:949-979.
Pretorius ES, Scott WW Jr, Fishman EK. Acute trauma of shoulder:role of spiral CT imaging . Emerg Radiol 1995;2:13-17.
Dalinka MK, Boorstein JM, Zlatkin MB. Computed tomography of musculoskele- tal trauma.Radiol Clin North Am 10. Wicky S, Blaser PF, Blanc CH, et al. Com- 1989;27:933-944.
Pate D, Resnick D, Andre M, et al. Pers- pective: Three-dimensional imaging of the musculoskeletal system. Am J Roentgenol AJR 1986;147:545-551.
McEnery KW, Wilson AJ, Pilgram TK, et al. Fracture of the tibial plateau: value of spiral CT coronal plane reconstructions for detecting displacement invitro. Am J Roentgenol AJR 1994;163:1177-1181.
Chan PS, Klimkkiewicz JJ, Lucdhetti WT, et al. Impact of CT scan ontreatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 1997;11:484- 489. parison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 2000;10:1227-1232.
Wicky S, Blaser PF, Blanc CH, et al. Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 2000;10:1227-1232.
te Stroet MA, Holla M, Biert J, et al. The value of a CT scancompared to plainradi- ographs for the classification and treat- mentplan in tibialplateaufractures. Emerg Radiol 2011;18:279-83.
Madig D, Michelsom JD, Ney DR, et al. Adult Ankle Fractures: Comparison of plain films and interactive two and three dimensional CT scans. Am J Roentgenol AJR 1990;154:1017-1023.
Leung KH, Fang CX, Lau TW, et al. Pre- operative radiography versus computedto- mography for surgical planning for ankle fractures. J Orthop Surg (Hong Kong)2016;24:158-162.
Franklin PD, Dunlop RW, Whitelaw G, et al. Computed tomography of the normal and traumatized elbow. J Comput Assist Tomogr1988;12:817-823.
Brouwer KM, Lindenhovius AL, Dyer GS, et al. Diagnostic accuracy of 2- and 3- dimensional imaging and modeling of dis- tal humerus fractures. J Shoulder Elbow Surg 2012;21:772-776.
Pearson JB, Hargadon EJ. Fractures of the pelvis involving the floor of theacetabu- lum. J Bone Joint Surg 1962;44:550-561.
Gill K, Bucholz RW. The role of compu- terized tomographic scanning in the evalu- ation of major pelvic fractures. J Bone Joint Surg 1984;66:34.
Griffits HJ, Standertskjold-Nordenstam CG, Burke J, et al. Computed tomography in the management of the acetabular frac- tures. Skeletal Radiol 1984;11:22.
Harley JD, Mack LA, Winquist RA: CT of acetabular fracture: Comparison with con- ventional radiography.Am J Roentgenol AJR 1982;138:413.
Magid D, Fishman EK: Computed to- mography of the acetabular fractures. Se- min US, CT, MR 1986;7:351.
Guy LR, Holder P, Brueton NR. The role of the 3D CT in the assessment of aceta- bular fractures.Br J Radiol 1992;65:384- 389.
Madig D, Fihman EK, Broker A.J, Jr., et al. Multiplanar computed tomography of the acetabular fractures. J Comput Assist- Tomogr 1986;10:778-783.
Bilet FP, Schmit WG, Gay B. Computed tomography in traumatology with special regard to the advances of three-dimensio- nal display. Arch Orthop Trauma Surg 1992;111:131-137.
Bahrs C, Rolauffs B, Südkamp NP, et al. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain ra- diography and computed tomography. BMC Musculoskelet Disord 2009;10:33.
Jurik AG, Albrechtsen J. The use of com- puted tomography with two- and three-di- mensional reconstructions in the diagnosis of three- and four-part fractures of the proximal humerus. Clin Radiol 1994;49:800-804.
Nakamura R, Horh E, Tanaka Y, et al. Three-dimensional CT imaging for wrist disorders. J Hand Surg1989;14:53-58.
You JS, Chung SP, Chung HS, et al. The usefulness of CT forpatients with carpal bone fractures in the emergency depart- ment. Emerg Med J 2007;24:248-250.