多层螺旋CT三维重建在肋骨骨折诊断及法医临床鉴定中的应用

Application of multi-slice spiral CT three dimensional reconstruction in the diagnosis and forensic clinical identification of rib fracture

目的探讨多层螺旋CT(MSCT)三维重建对肋骨骨折的诊断价值及其在法医临床鉴定中的应用。方法采用胸部正位(部分斜位)摄片,对60例胸部外伤患者进行数字X线摄影检查,同时进行MSCT检查并进行三维重建。结果 60例胸部外伤患者共有肋骨骨折102处。X线摄影发现肋骨骨折88处,确诊率为86.27%,MSCT三维重建发现肋骨骨折100处,确诊率为98.04%,两种检查方法确诊率比较,差异具有统计学意义(P<0.01)。102处肋骨骨折中有90例发生于3~10肋骨(占88.24%),而1~2肋骨、11~12肋骨骨折分别为7例(占6.86%)和5例(占4.90%)。多发性肋骨骨折72例(占70.59%),单发性肋骨骨折30例(占29.41%)。结论外伤所致肋骨骨折好发于第3~10肋,且多为多发肋骨骨折。MSCT三维重建诊断肋骨骨折的漏诊率显著低于X线摄影,能为肋骨骨折相关的法医临床鉴定提供更为准确详尽的证据。

Objective To explore the diagnostic value of multi-slice spiral computerized tomography（MSCT） three dimensional（3D） reconstruction of rib fracture and the application of forensic clinical identification. Methods Digital radiography（DR）, MSCT 3D reconstruction were used to diagnose the rib fracture in 60 patients, the position was selected on chest position（partial oblique）. Results Sixty cases of chest trauma patients with rib fractures in 102. There were 88 rib fractures diagnosed by digital radiography, the diagnosis rate was 86.27%; and 100 cases of rib fracture were diagnosed by MSCT 3D reconstruction, the diagnosis rate was 98.04%, the difference of the diagnosis rate between the two methods was statistically significant（P〈0.01）. Of 102 rib fracture, 90 cases were occurred in 3-10 rib（88.24%）; 7 cases were occurred in 1-2 rib（6.86%）; 5 cases were occurred in 11-12 rib（4.90%）; 72 cases were multiple rib fractures（70.59%） and 30 cases were single rib fracture（29.41%）. Conclusion The rib fracture caused by trauma are common in the 3-10 rib and that were mostly multiple rib fractures. The missed diagnosis rate of MSCT 3D reconstruction was significantly lower than that of digital radiography, which suggests that the MSCT 3D reconstruction can provide more accurate and detail evidence for forensic clinical identification of rib fractures.