多种影像检查技术在肋骨骨折法医鉴定中的应用价值

The Application Value of Multiple Imaging Techniques in the Medicolegal Expertise Rib Fracture Diagnosis

目的:探讨多种影像检查技术在肋骨骨折法医鉴定中的应用价值。方法:回顾性分析2016年7月～2017年6月在本院进行肋骨骨折检查的患者256例,对同一患者的DR、多排螺旋CT横断位、MPR、VR等多种图像进行对比;同时对屏气情况进行分组,以分析不同呼吸状态下,不同影像学技术在肋骨骨折法医鉴定中的应用价值。结果:256例患者中,DR发现骨折465处,可疑骨折126处,漏诊骨折255处;多排螺旋CT横断位扫描发现骨折658处,可疑骨折80例,漏诊骨折108处; MPR发现骨折705处,可疑骨折86处,漏诊骨折55处; VR发现骨折470处。可疑骨折105处,漏诊骨折271处;多排螺旋CT横断位+MPR+VR发现骨折736处,可疑骨折62处,漏诊骨折48处;法医学鉴定时发现骨折781处,可疑骨折65处。不同检查方式间在肋骨骨折的诊断上存在统计学差异。屏气成功组中439处肋骨骨折未受干扰,48处肋骨骨折受到干扰;屏气未成功组中207处肋骨骨折未受干扰,152处肋骨骨折受到干扰;屏气是否成功对肋骨骨折诊断的干扰存在统计学差异。结论:严格的屏气训练后屏气状态下的多排螺旋CT横断位+MPR+VR发现肋骨骨折的准确性最高,对法医鉴定具有重要意义。

Objective:To explore the application value of multiple imaging techniques in the medicolegal expertise rib fracture diagnosis.Methods:256 cases with rib fractures received radiologic examinations in our hospital from July 2016 to June 2017 were analyzed retrospectively.The images of digital radiography(DR),axial view of multi-spiral computed tomography(MSCT),multiplanar reconstruction(MPR) and volume rendering(VR) were compared and analyzed for each patient.Different groups were divided according to the breath-holding condition in order to analyze the value of various imaging methods in the medicolegal expertise of rib fractures.Results:The number of diagnosed rib fractures,uncertain rib fractures,omissive rib fractures were 465,126,255 detected by DR;658,80,108 detected by MSCT;706 ,86 ,55 detected by MPR;470,105,271 detected by VR;736,62,48 detected by united MSCT techniques,respectively.Finally,781 locations of rib fractures were diagnosed and 65 locations of uncertain fractures were found by medicolegal expertise.The diagnosis accuracy among these imaging methods was statistically different.439 places of fractures were not affected and 48 places of fractures were affected in successful breath-holding group while 207 places of fracture were not affected and 152 places were affected in failed breath-holding group.Significant statistical different were found between the two breath-holding groups.Conclusion:The combi nation of axial view of MSCT,MPR and VR has the highest accuracy in lhe diagnosis of rib fracture under the stable breath-holding situation after strict breath-holding training,and medicolegal expertise workability will be improved.