单侧骨皮质凹陷对不完全性肋骨骨折的阳性预测值分析

Analysis of Positive Predictive Value of Unilateral Cortical Depression of Rib for Incomplete Rib Fracture

目的探讨及分析单侧骨皮质凹陷征对不完全性肋骨骨折的阳性预测值(PPV),以提高对骨皮质凹陷征象的认识。方法回顾性分析本院2015年1月至2017年12月因单侧肋骨骨皮质凹陷被诊断为不完全骨折的94例外伤患者资料,首次CT检查为伤后1周内,且在受伤后的3~8周进行了胸部CT复查。结果94例患者共有187处肋骨骨皮质凹陷,位于第3~8前肋,其中肋骨内侧面骨皮质凹陷158处,外侧面骨皮质凹陷29处;单发骨皮质凹陷135处,多发骨皮质凹陷或伴有邻近肋骨骨折52处。凹陷处有胸膜反应或邻近肺内渗出20处。在伤后的3~8周复查胸部CT,154处(82.35%)骨皮质凹陷被证实为不完全性肋骨骨折,33处(17.65%)骨皮质凹陷处因无骨质改变或骨膜反应,被排除不完全性骨折。单侧骨皮质凹陷对不完全性肋骨骨折的PPV值为82.35%;其中肋骨内侧面的骨皮质凹陷预测不完全性骨折的PPV值为92.4%,显著高于外侧面的骨皮质凹陷(PPV值:27.59%,P<0.001)。结论单侧骨皮质凹陷对不完全性肋骨骨折的PPV值较高,且位于肋骨内侧面的凹陷较外侧面具有更高的PPV值。

Objective to investigate and analyze the positive predictive value(PPV)of unilateral cortical depression of the rib for incomplete rib fracture.Methods Retrospective analysis of the clinical data in our hospital from January 2015 to December 2017,94 patients diagnosed with incomplete fracture by cortical depression of the rib were included.The first-time chestCT examinationswere within one week of injury,and 3 to 8 weeks afterinjury to reexamine chest CT.Results there were 187 corticaldepressions of the rib in 94 patients,located in the 3-8 anterior rib.There were158cortical depres-sions in the inner side of rib and 29 in the outer side.135 corticaldepressions occur alone,52 corticaldepressions were con-current or definite adjacent rib fractures.20 cortical depressions had concurrent adjacent pleural reaction and pulmonary consolidation.The chest CT was reviewed 3 to 8 weeks after injury.154 cortical depressions(82.35%)were confirmed as incomplete rib fractures.33 Incomplete fractures(17.65%)were excluded,because there were no reactions in rib density and periosteum.The PPV value of unilateral cranial cortex depression for incomplete rib fracture was 82.35%.Among them,the PPV of unilateral cortical depression in the inner side of rib was 92.4%,significantly higher than that in the out-er side(PPV:27.59%,P<0.001).Conclusion Unilateral cortical depression of the rib has a higher positive predic-tive value for incomplete rib fracture,and a higher PPV was found in the inner side of the rib compared with the outer side of the rib.