股骨颈隐性创伤性骨折的影像学诊断及漏诊原因分析

Imaging Diagnosis of Recessive Traumatic Femoral Neck Fracture and Reasons of Missed Diagnosis

目的探讨计算机体层摄影(CT)与磁共振成像(MRI)对股骨颈隐性创伤性骨折的诊断价值。方法收集2015年6月至2019年6月咸宁市中心医院收治的82例股骨颈隐性创伤性骨折患者影像资料,均行CT及MRI检查,比较两种检查方法对股骨颈隐性创伤性骨折的检出率。结果 82例患者,CT诊断可疑骨折16例,表现为骨皮质出现轻度扭曲;60例明确诊断为骨折,表现为骨皮质、骨小梁呈连续性中断,骨折断端显示良好对位。MRI诊断为明确骨折77例,T_(1)WI显示骨皮质连续性中断、骨髓腔有线状或条状低信号影;脂肪抑制序列可见线状或条状高信号影。CT对股骨颈隐性创伤性骨折的检出率为73.17%(60/82),MRI对股骨颈隐性创伤性骨折的检出率为93.9%(77/82),二者比较差异有统计学意义(χ^(2)=12.813,P<0.05)。结论 MRI相比CT对股骨颈隐性创伤性骨折的检出率更高,对于可疑骨折且CT表现阴性者,应进一步行MRI检查以减少漏诊。

Objective To explore the diagnostic value of computed tomography(CT)and magnetic resonance imaging(MRI)for recessive traumatic femoral neck fracture.Methods The imaging data of 82 patients with recessive traumatic femoral neck fractures admitted to the Xianning Central Hospital from June 2015 to June 2019 were collected.All underwent CT and MRI.The detection rates of the two methods for recessive traumatic femoral neck fractures were compared.Results Of the 82 patients,there were 16 cases suspected with fractures diagnosed by CT,showing mild distortion of cortical bone.There were 60 cases confirmed with fractures,showing continuous interruption of cortical bone and trabecular bone.And fracture ends showed good alignment.There were 77 cases with fractures diagnosed by MRI.T1WI showed continuous interruption of cortical bone.There was linear or striplike low signal shadow in medullary cavity.The linear or strip-like high signal shadow was seen in fat suppression sequence.The detection rates of CT and MRI for recessive traumatic femoral neck fracture were 73.17%(60/82)and 93.9%(77/82),respectively(χ^(2)=12.813,P<0.05).Conclusion Compared with CT,detection rate of MRI is higher for recessive traumatic femoral neck fracture.For patients with suspected fractures and negative CT findings,MRI should be further performed to reduce missed diagnosis.