不同影像学方法诊断踝关节隐匿性骨折的准确率比较

Comparison of Accuracy Rate of Different Imaging Methods in the Diagnosis of Occult Fractures of Ankle Joint

目的探讨磁共振(MRI)和多层螺旋CT(MSCT)诊断踝关节隐匿性骨折的准确性。方法回顾性分析2016年5月-2018年5月我院骨科收治的69例拟诊为踝关节隐匿性骨折患者的临床资料。所有患者的X线检查呈阴性或可疑踝关节骨折,外伤后7d内行MRI和MSCT检查。以手术病理检查为"金标准",分析MRI和MSCT检查对踝关节隐匿性骨折的诊断准确性,并比较两种检查方法的诊断差异性。结果踝关节隐匿性骨折MRI表现,T1WI序列显示片状不均匀的低或略低信号,T2WI序列显示高或略高信号,STIR序列显示明显高信号;MSCT表现为骨质连续性中断或伴骨折线,移位骨折与局部骨折缺损吻合;MRI检查的诊断灵敏度和准确率均高于MSCT检查(P<0.05),特异度略高于MSCT检查,但差异无统计学意义(P>0.05)。结论 MRI和MSCT检查对踝关节隐匿性骨折有较高的诊断价值,但MRI的灵敏度和准确率更高,可作为检查的首选、以为临床提供更精确的影像学资料。

Objective To explore the accuracy of magnetic resonance imaging(MRI)and multi-slice spiral CT(MSCT)in the diagnosis of occult fractures of ankle joint.Methods The clinical data of 69 patients with occult fractures of ankle joint who were treated in orthopedics department of our hospital from May 2016 to May 2018 were analyzed retrospectively.X-ray examination of all patients was negative or suspicious ankle fractures,and MRI and MSCT were performed in patients within 7 d after trauma.Surgical pathological examination was used as the"gold standard"to analyze the diagnostic accuracy of occult fractures of ankle joint by MRI and MSCT,and the diagnostic differences between the two methods were compared.Results MRI findings of occult fractures of ankle joint,T1 WI sequence showed schistose and uneven low or slightly low signal,and T2 WI sequence showed high or slightly high signal,and STIR sequence showed obvious high signal.MSCT findings showed interruption of bone continuity or fracture line shadow,and displaced fracture and local fracture defect were consistent.The diagnostic sensitivity and accuracy of MRI were higher than those of MSCT(P<0.05),and the specificity was slightly higher than that of MSCT(P >0.05).Conclusion MRI and MSCT have high diagnostic value for occult fractures of ankle joint,but MRI has higher sensitivity and accuracy,and it can be used as the first choice for examination to provide more accurate imaging data.