多层螺旋CT三维重建技术在诊断肋骨隐匿骨折及细微骨折好发部位的价值

The value of multi-slice spiral CT three-dimensional reconstruction technology in the diagnosis of occult rib fractures and the prone sites of microfractures

目的探讨多层螺旋CT三维重建技术在诊断肋骨隐匿骨折及细微骨折好发部位的价值。方法回顾性选取2019年9月至2020年1月于我院就诊肋骨骨折患者50例(骨折共323根,隐匿性骨折数26根,细微性骨折89根),所有患者均在首次入院时进行多层螺旋CT检查和数字化X线摄影(DR)检查,并根据复查方法分为CT组和DR组,随后在距入院时3、4、6周行多层螺旋CT及DR复查,并分析复查期间新检出骨折的发生情况及发生部位。结果首次多层螺旋CT检查结果显示骨折共297根,其中细微性骨折89根;首次DR检查结果显示骨折共297根,其中细微性骨折89根;复查期间新检出隐匿性骨折15例,CT组在第3周、4周、6周复查时新检出隐匿性骨折分别为8、13、4根;DR组在第3周、4周、6周复查时新检出隐匿性骨折分别为6、13、3根。肋骨隐匿性骨折好发于肋骨角、骨小梁、肋骨内外缘;细微骨折好发于肋软骨处、肋骨内外缘及肋骨角。结论多层螺旋CT三维重建技术诊断肋骨隐匿性骨折及细微性骨折正确率高于DR检查;肋骨隐匿性骨折和细微性骨折好发于肋骨角、肋骨内外缘等部位,临床中应在首次检查后3~6周后进行CT复查,以提高诊断率。

Objective To explore the value of multi-slice spiral CT three-dimensional reconstruction technology in the diagnosis of concealed rib fractures and the prone sites of small fractures.Methods Retrospectively,50 patients with rib fractures(a total of 323 fractures,26 occult fractures,and 89 subtle fractures)who were admitted to our hospital from September 2019 to January 2020 were selected.All patients underwent multi-slice spiral CT examination and DR examination at the first admission,and were divided into CT group and DR group according to the review methods.MSCT and DR were performed at 3,4 and 6 weeks from admission,and the occurrence and location of new fractures were analyzed during the review.Results The first multi-slice spiral CT examination showed a total of 297 fractures,including 89 minor fractures,the first DR examination showed a total of 297 fractures,including 89 minor fractures,15 new cases with occult fractures were detected during the reexamination In the CT group,8,13,and 4 new occult fractures were detected in the 3rd,4th,and 6th week re-examinations,respectively,in the DR group,the occult fractures were newly detected in the 3rd,4th,and 6th week re-examinations.They are 6,13,and 3 respectively.Occult rib fractures usually occur at the rib angle,trabecular bone,inner and outer edges of the ribs;subtle fractures usually occur at the costal cartilage,inner and outer edges of the ribs,and rib angles.Conclusion The accuracy of multi-slice spiral CT three-dimensional reconstruction technology in diagnosing occult rib fractures and subtle fractures is higher than that of DR examination,occult rib fractures and subtle fractures are more likely to occur in rib angles,inner and outer edges of ribs,and should be the first time in clinical practice.CT re-examination is performed 3 to 6 weeks after the examination to improve the diagnosis rate.