MRI检查对隐匿性胫骨平台骨折的诊断效能

Effect of MRI on diagnostic efficacy of occidental tibial plateau fractures

目的探讨磁共振成像(MRI)对隐匿性胫骨平台骨折(TPOF)的诊断效能。方法回顾性分析2018-08—2020-02于郑州市骨科医院行手术治疗的104例拟诊为TPOF患者的临床资料。以术中所见及术后随访结果为"金标准",评价术前MRI、CT的诊断准确度、灵敏度、特异度、误诊率、漏诊率、累及骨皮质检出率,以及图像清晰度。结果以隐匿性胫骨平台骨折为阳性、非隐匿性胫骨平台骨折为阴性。104例TPOF患者中,术中所见及术后随访结果为阳性73例,阴性31例。MRI检查阳性70例,阴性34例。CT检查阳性63例,阴性41例。MRI诊断TPOF准确度为96.15%(100/104)、灵敏度为95.89%(70/73)、特异度为96.77%(30/31),分别高于CT检查的82.69%(86/104)、86.30%(63/73)、74.19%(23/31)。MRI的漏诊率为4.11%(3/73)、误诊率为3.23%(1/31),分别低于CT的13.70%(10/73)、25.81%(8/31);MRI累及骨皮质的检出率为76.27%(45/59),低于CT的91.53%(54/59);MRI的错位程度、塌陷程度、周围结构及骨折部位等图像清晰度均高于CT。以上差异均有统计学意义(P<0.05)。结论 MRI检查应用于TPOF诊断,可提高诊断准确度、灵敏度、特异度,降低漏诊率、误诊率,图像清晰度高,有利于为临床治疗方案制定提供指导,具有重要的临床诊断价值。

Objective To investigate the diagnostic efficacy of magnetic resonance imaging(MRI)in occult tibial plateau fracture(TPOF).Methods The clinical data of 104 patients with TPOF who underwent surgery in Zhengzhou orthopedic hospital from August 2018 to February 2020 were analyzed retrospectively.Taking the intraoperative findings and postoperative follow-up results as the"gold standard",the diagnostic accuracy,sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,quality inspection rate involving bone skin and image clarity of preoperative MRI and CT were evaluated.Results Occult tibial plateau fractures were positive and non occult tibial plateau fractures were negative.The intraoperative and postoperative follow-up results of 104 patients with TPOF were positive in 73 cases and negative in 31 cases.MRI was positive in 70 cases and negative in 34 cases.CT examination was positive in 63 cases,negative in 41 cases.The accuracy,sensitivity and specificity of MRI in the diagnosis of TPOF were 96.15%(100/104),95.89%(70/73)and 96.77%(30/31),which were higher than 82.69%(86/104),86.30%(63/73)and 74.19%(23/31)of CT,respectively.The missed diagnosis rate of MRI was 4.11%(3/73)and the misdiagnosis rate was 3.23%(1/31),which were lower than 13.70%(10/73)and 25.81%(8/31)of CT,respectively;The detection rate of cortical involvement on MRI was 76.27%(45/59),which was lower than 91.53%(54/59)on CT;The degree of dislocation,collapse,surrounding structure and fracture site of MRI were higher than those of CT.The above differences were statistically significant(P<0.05).Conclusion The application of MRI in the diagnosis of TPOF can improve the diagnostic accuracy,sensitivity and specificity,reduce the missed diagnosis rate and misdiagnosis rate,and have high image definition.It is conducive to provide guidance for the formulation of clinical treatment plan,and has important clinical diagnostic value.