桡骨远端Die-punch骨折的CT表现及其影像分型

CT imaging and typing in Die-punch fractures of the distal radius

目的：分析桡骨远端Die-punch骨折的CT表现，并探讨其影像分型在临床精准诊断及手术方案制定中的价值。方法回顾性分析2009年1月至2015年8月符合纳入标准的，39例桡骨远端Die-punch骨折患者的临床及影像资料。所有患者均行X线平片和CT检查，由2名高年资诊断医师对影像结果进行双盲法阅片。根据桡骨远端Die-punch骨折的影像表现规律及治疗方式，制定其影像分型。结果根据桡骨远端Die-punch骨折的CT表现特点，其影像分型结果为：Ⅰ型（背侧型）13例，Ⅱ型（掌侧型）7例，Ⅲ型（劈裂型）9例，Ⅳ型（塌陷型）10例。CT诊断此类骨折的准确率为100.0%（39/39）；X线平片的漏诊率为10.3%（4/39），分型误判率为17.1%（6/35）。结论 CT能够明确诊断桡骨远端Die-punch骨折，并进行术前影像分型。

Objective To explore its imaging types by analyzing CT features of Die-punch fractures of the distal radial in order to provide accurate diagnosis and preoperative guidance. Methods A retrospective analysis was made from January 2009 to August 2015 in 39 cases met the inclusion criteria for Die-punch fractures of the distal radius, all patients＇ plain radiographs and CT examinations were read by two senior diagnostic radiologists with double blind method. According to imaging findings and therapeutic method, the radiological classification of Die-punch fractures was proposed. Results There were four types for Die-punch fractures of the distal radius based on the CT imaging features. TypeⅠ：dorsal type in 13 cases. TypeⅡ：volar type in 7 cases patients with palmar type. TypeⅢ：slitting type in 8 cases. TypeⅣ：collapsed type in 11 cases. CT diagnostic accuracy for such fractures was 100.0%;the rate of missed diagnosis by plain radiograph was 10.3% （4/39） with misjudgment misdiagnosis rate of 17.1% （6/35）. Conclusions CT scanning was able to provide not only definitive diagnosis and radiological types of distal radial Die-punch fracture, but also an important guiding tool for clinical treatment and choice of surgical approach.