首次X光平片两位片法与四位片法检查对急性膝外伤诊断效果的比较

Compare of diagnostic effect between anteroposterior(AP) and lateral views and four views in the first X-ray detection of acute knee trauma

目的:确定前后位与侧位(常规)两位摄片是否与急性膝关节骨折检查中四种多体位摄片效果相当。方法:92例急诊外科收诊的急性膝关节外伤患者,首诊时摄至少四位置膝关节平片。3位专攻骨骼系统方面的放射科专家回顾性审阅了每个患者的膝关节平片,确认是否存在骨折。所有病例均经4位非本院高年资放射科医师两次阅片:一次为常规两位置平片,另一次为四位置平片。为了减少回忆性偏见,两次阅片时间间隔4周,并对其敏感性、特异性、诊断表现进行统计学分析。结果:四位平片发现骨折的平均敏感性(85%)与两位平片发现骨折的平均敏感性(79%)存在统计学差异。4位阅片者阅片能力与特异性没有统计学差异。结论:膝关节四位平片比常规两位平片在发现急性膝关节骨折方面更为敏感。

Objective： To determine whether anteroposterior （AP） and lateral views of the knee are equivalent to the four views in acute fracture detection. Methods： Ninety-two patients presenting to the emergency department with acute knee trauma were evaluated with at least a four-view plain film examination. Three musculoskeletal radiologists retrospectively interpreted the plain film examinations of each patient, to establish the ground truth for the presence or absence of a fracture. Cases were presented to four senior radiologists twice - once as a two-view study and again as a four-view study -with 4 weeks separated between the two reading sessions to minimize recall bias. Sensitivity, specificity and diagnostic performance were calculated. Results： Mean sensitivity for fracture detection using four views （85%） was significantly higher than that of using two views （79%）. Mean specificity and receiver operating characteristic curve areas were not significantly different using two or four views. Conclusion： Four views are more sensitive than AP and lateral views alone in detection of acute knee fracture.