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Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures.

三维ct重建在胫骨平台后侧骨折治疗中的价值 [j].

  • 影响因子:2.04
  • DOI:10.1016/j.knee.2019.11.001
  • 作者列表:"Van den Berg J","Struelens B","Nijs S","Hoekstra H
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Indication for surgical treatment of posterior tibial plateau fractures (TPFs) remains up for debate. Three-dimensional computed tomography (3D-CT) reconstruction can provide insight into fracture morphology and could improve treatment strategy and surgical planning. In this study, we investigated the value of 3D-CT reconstruction in the treatment of posterior TPF and evaluated the influence on surgical decision-making. METHODS:CT images of 34 cases with a TPF involving the posterior column were included and digitally presented to a panel of five international observers at two intervals. At the first evaluation, only coronal, axial and sagittal images were shown. After an interval of at least three weeks, 3D-CT reconstruction images were added. During both surveys, observers were asked to classify the TPF according to the revised three-column classification (rTCC), as well as to define operative strategy. RESULTS:When using 2D images, overall multirated kappa value was 0.48, with an average pairwise agreement of 68%. After adding 3D images, overall multirated kappa value was 0.43, with average pairwise agreement of 67%. Hierarchical logistic regression of decision to operate on image condition (3D vs. 2D) shows an odds ratio of 2.01 (95% confidence interval, 1.11-3.67), P = .022. Increase in operative indication was seen mainly in posterolateral fractures. CONCLUSION:This study investigated the value of 3D classification in the treatment of posterior column TPF. Contrary to expectations, the addition of 3D images to the assessment did not reduce but rather appeared to increase operative indications, especially in fractures involving the posterolateral region.

摘要

背景: 胫骨平台后侧骨折 (TPFs) 手术治疗的适应证仍有待商榷。三维计算机断层扫描 (3D-CT) 重建可以提供对骨折形态的洞察,并且可以改进治疗策略和手术计划。本研究探讨三维ct重建技术在后路TPF治疗中的应用价值,并评价其对手术决策的影响。 方法: 包括34例累及后柱的TPF患者的CT图像,并以两次间隔向五名国际观察员小组数字化呈现。在第一次评估时,仅显示冠状、轴向和矢状图像。间隔至少三周后,添加3D-CT重建图像。在这两次调查期间,观察员被要求根据修订的三栏分类 (rTCC) 对TPF进行分类,并确定运作战略。 结果: 当使用2D图像时,总体多分kappa值为0.48,平均成对一致性为68%。添加3D图像后,总体多分kappa值为0.43,平均成对一致性为67%。决定在图像条件下操作的分层逻辑回归 (3D vs. 2D) 显示2.01的比值比 (95% 置信区间,1.11-3.67),p   =  .022。手术指征增加主要见于后外侧骨折。 结论: 本研究探讨三维分类在后柱TPF治疗中的价值。与预期相反,在评估中增加3D图像并没有减少,而是似乎增加了手术适应症,特别是在涉及后外侧区域的骨折中。

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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DOI:10.1002/jcu.22762
作者列表:["Meng L","Zhao D","Yang Z","Wang B"]

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