DR与多层螺旋CT三维重建技术在肋骨骨折诊断中的对比应用

Comparison Application in Diagnosis of Traumatic Rib Fractures by Direct Radiography and Multislice CT Three-dimensional Reconstruction Technique

目的对比研究16层螺旋CT三维重建与DR平片对外伤性肋骨骨折的诊断价值。方法对解放军白求恩国际和平医院2012年1月—2013年1月收治的72例外伤性肋骨骨折分别行DR摄片及16层螺旋CT三维重建检查。统计骨折部位,比较两种检查方法肋骨骨折确诊率及骨折合并症检出情况。结果 72例经临床及影像学证实共157处肋骨骨折,肋骨骨折多发(63.1%)多于单发(36.9%),大多发生于4～10肋(82.2%)及腋段(52.9%)。16层螺旋CT三维重建对肋骨骨折的确诊率(96.2%)显著高于DR平片(80.3%,P<0.01);螺旋CT三维重建对肋骨骨折的漏诊率(3.8%)显著低于DR平片(19.7%,P<0.01)。16层螺旋CT三维重建尚发现其他部位骨折19处及肺部合并症16例。结论应用16层螺旋CT三维重建极大提高了肋骨骨折的诊断准确率,在诊断隐匿性肋骨骨折及并发症方面其临床价值明显优于DR平片。

Objective To study the diagnosis value of traumatic rib fractures by 16-slice spiral CT three-dimen- sional reconstruction and direct radiography （DR） plain film. Methods A total of 72 patients with traumatic rib fracture in our hospital during January 2012 and January 2013 underwent DR photographs and 16-slice spiral CT three-dimensional reconstruction examinations. Final diagnosis rates and detection rates of fracture complication by the two methods were compared. Results There were 157 rib fractures in 72 patients confirmed by clinical and iconography, and rate of multi- ple rib fractures （63.1%） was larger than that of single （36.9%） , most of whom occurred in the 4-10 ribs （82.2%） and axillary segment （52.9%）. Final diagnosis rate （96.2%） by 16-slice spiral CT three-dimensional reconstruction was significantly higher than that （ 80.3% ） by DR plain film （P 〈 0.01 ） ; missed diagnosis rate （ 3.8% ） by 16-slice spiral CT three-dimensional reconstruction was significantly lower than that （ 19.7% ） by DR plain film （ P 〈 0.01 ）. Other 19 fractures and 16 patients with lung complications were found by 16-slice spiral CT reconstruction. Conclusion The technic of spiral CT three-dimensional reconstruction may greatly improve the diagnostic accuracy of rib fractures, and the clinical value in diagnosis of dormant rib fractures and complication by it is obviously better than that by DR plain film.