参训新战士胫骨疲劳骨折早期X线阴性诊断原因分析

Analysis of the Reasons about Negative Diagnosis by Early X-ray Films of New Soldiers with Fatigue Fracture

目的:分析新训战士疲劳骨折早期X光片阴性诊断原因。方法:回顾分析近12年31例确诊前首次X光片报告阴性的胫骨疲劳骨折临床表现、影像学资料。结果:31例35张光片中6例X光片质量欠佳;19例局部有单纯软组织肿胀增厚影;4例侧位重叠不能识别胫骨被腓骨遮挡骨皮质;1例骨小梁显示局限性密度稍高;1例局部骨皮质稍变薄、边缘稍模糊、呈灰色骨皮质征;2例外骨皮质侧见轻微光滑均匀丘状隆起;6例行MR检查明确诊断为疲劳骨折。结论:在提高阅片水平前提下要注意X光片质量及体位重叠影响。当X光片只见局部软组织改变时,应重视并结合临床表现,有可能处于"疲劳骨折前期",而诊断疑难或需鉴别时,MR是有用手段。

Objective： To analyze the cause of negative diagnosis by early X-ray Films of New soldiers with fatigue fracture. Methods： To review and analyze the clinical manifestation and the imaging data of 31 patients who were diagnosed negatively by the first X-ray Films before final diagnose. Results： 6 patients＇ X-ray Films of 31 patients＇ 35 films had quality defect; 19 patients＇ X-ray Films showed a local thickening of Soft tissue swelling; 4 cases showed a side overlap that the cortical bone of tibia could not be seen under the blocking of fibula; one case showed a shadow of local higher density in trabecula; one case showed a local cortical thickness, edge blur and become gray; 2 cases showed slight smooth bone bulging on tibia outside cortical bone; 6 patients were definitely diagosed as fatigue fracture by MR imaging. Conclusion： Under the precondition of improving the level of read a slice, more attention should be given to the quality of X-ray Films and the influence of postures overlap. When X-ray Films show only local soft tissue changes, diagnosis needs the combination of clinical presentation, because it may be in the early stage of fatigue fracture. If it is difficult to diagnose or needs to be differentiated, MR is an effective help.