CT和MRI在胫腓骨螺旋骨折合并后踝隐匿性骨折中的诊断价值

Imaging diagnosis of spiral tibiofibular fracture combined with occult fracture of posterior malleolus

目的 探讨CT、MRI在胫腓骨螺旋骨折合并后踝隐匿性骨折中的诊断价值.方法 对2007年7月至12月收治的39例胫腓骨螺旋骨折合并后踝隐匿性骨折患者的资料进行分析,其中男30例,女9例;平均年龄39.9岁;左侧15例,右侧24例.39例患者术前均行X线、CT和MRI检查,根据结果做出诊断并分别统计上述方法对后踝隐匿性骨折的显示情况. 结果 本组胫腓骨螺旋骨折同时合并后踝骨折30例,胫骨螺旋骨折合并后踝骨折7例,腓骨螺旋骨折合并后踝骨折2例.患者后踝均为斜形裂纹骨折,其中长斜形骨折30例,短斜形骨折9例;后踝骨折轻度分离7例.X线片、CT、MRI对后踝骨折的诊断准确率分别为10.3%、94.9%、100%,假阴性率分别是89.7%、5.1%、0,假阳性率均为0. 结论 CT、MRI可以提高胫腓骨螺旋骨折患者合并后踝隐匿性骨折的诊断率.MRI是显示后踝隐匿性骨折最敏感的检查方法.

Objective To evaluate the diagnostic value of CT and MRI for the spiral tibiofibular fracture combined with the occult fracture of posterior malleolus. Methods From July 2007 to December 2007, 39 patients were admitted to our hospital for the spiral tibiofibular fracture combined with the posterior malleolar fracture. Their radiographs, CT and MRI images were analyzed and compared. Results The imaging diagnosis revealed that 30 cases of spiral tibial and fibular shaft fractures, 7 cases of spiral tibial shaft fractures and 2 cases of spiral fibular shaft fracture had been complicated with the occult fracture of posterior malleolus. We found 30 long and 9 short oblique crack fractures, including 7 slightly dislocated fractures. The diagnostic accuracy for the posterior malleolar fracture was 10. 3%, 94. 9% and 100% in plain films, CT images and MRI images, respectively; the false negative rate for the posterior malleolar fracture was respectively 89. 7%, 5. 1% and 0. Conclusion CT and MRI can improve the diagnostic accuracy of the occult posterior malleolar fracture and MRI is the most sensitive examination.