The Indispensable Significance Of MSCT 3-D Reconstruction Techniques In Guiding The Treatment And Typing Of Proximal Humerus Fractures

OBJECTIVE: TO INVESTIGATE THE APPLICATION OF THE MULTI-SLICE CT(MULTI-SLICE SPIRAL COMPUTED TOMOGRAPHY, MSCT)RECONSTRUCTION TECHNIQUES IN DIAGNOSING PROXIMAL HUMERUS FRACTURES, EVALUATE THE VALUE IN GUIDING THE TREATMENT OF THE PROXIMAL HUMERUS FRACTURES. METHODS: (1) 20 CASES OF PROXIMAL HUMERUS FRACTURES WERE EXAMINED WITH ROUTINE X-RAY WAY, INCLUDING ANTEROPOSTERIOR POSITION AND LATERAL POSITION THROUGH CHEST. FURTHERMORE, THOSE WERE ALSO SCANNED WITH MSCT, INCLUDING THE PROXIMAL HUMERUS AND THEN RECONSTRUCTED THREE-DIMENSIONAL IMAGES. (2) THESE 20 CASES WERE CLASSIFIED WITH THE STANDARDS OF NEER'S CLASSIFICATION, ACCORDING TO X-RAY PLAIN FILM, TWO-DIMENSIONAL CT FILM AND THREE-DIMENSIONAL RECONSTRUCTION FILM. THE WORK WAS DONE TWICE BY FIVE ORTHOPEDISTS RESPECTIVELY, WITH AN INTERVAL OF THREE MONTHS. RESULTS: (1) THREE-DIMENSIONAL RECONSTRUCTION OF PROXIMAL HUMERUS COULD SHOW SPATIAL RELATION OF FRACTURES CLEARLY, WHICH HOLDS MORE INFORMATION THAN ROUTINE X-RAY. FRACTURED FRAGMENTS OF 12 CASES WERE ONLY FOUND BY THE FORMER. 2 THERE IS STATISTICAL DIFFERENCE IN SUCH CLASSIFICATION USING X-RAY(P<0.05) AND TWO-DIMENSIONAL CT (P<0.05) RESPECTIVELY CLASSIFICATION WITH AN INTERVAL OF THREE MONTHS ACCORDING TO NEER'S CLASSIFICATION, HOWEVER, NO STATISTICAL DIFFERENCE IS FOUND USING THREE-DIMENSIONAL RECONSTRUCTION(P>0.05). CONCLUSION: ALTHOUGH X-RAY PLAIN FILM IS THE FIRST IMAGING EXAMINATION FOR OSTEOARTICULAR TRUMA, IN ORDER TO AVOID MISDIAGNOSIS AND MISSED DIAGNOSIS, MSCT IS RECOMMENDED IN CASES WITH THE EQUIVOCAL DIAGNOSIS. MSCT 3-D RECONSTRUCTION TECHNIQUES ARE NOT ONLY USEFUL TO ASSESS THE DETAILS OF INTRA-ARTICULAR FRACTURES AND THE INJURY OF ARTICULAR, BUT ALSO IS HELPFUL IN GUIDING TREATMENT OF PROXIMAL HUMERUS FRACTURES.