螺旋CT诊断外伤性膝关节隐性骨折的影像表现及临床价值

Imaging Manifestations and Clinical Value of Spiral CT in the Diagnosis of Traumatic Knee Joint Fractures

目的 探究128层螺旋CT诊断外伤性膝关节隐性骨折的影像表现及临床价值。方法 选取2018年4月至2019年12月在我院接受治疗的外伤性膝关节骨折患者83例,回顾性分析其病历资料,均接受手术治疗,术前行128层螺旋CT检查。分析128层螺旋CT检查对膝关节隐形骨折的诊断准确率、预测价值及其与手术证实结果的一致性,统计隐形骨折分布部位,分析其影像学表现。结果 83例患者经手术诊断,其中76例为膝关节隐形骨折,128层螺旋CT检查对隐性骨折的诊断率为81.58%(62/76);128层螺旋CT扫描诊断膝关节隐性骨折的特异性及敏感度均较高(82.9、94.3);128层螺旋CT检查与手术诊断结果的Kappa一致性检验优(Kappa>0.69);128层螺旋CT扫描共检出62例隐形骨折,共86处骨折部位,其中胫骨近端、髁间嵴、腓骨近端、髌骨出现隐形骨折患者比例高;膝关节隐性骨折的128层螺旋CT检查象征:骨质呈连续性中断,移位骨折和局部骨折之间缺少吻合。结论 128层螺旋CT对外伤性膝关节隐性骨折诊断价值高,临床可将该检查技术用于X线难以分辨的膝关节隐匿性骨折临床诊断。

Objective To investigate the imaging manifestations and clinical value of 128-slice spiral CT in the diagnosis of traumatic knee joint recessive fracture. Methods 83 patients with traumatic knee joint recessive fracture underwent surgery in our hospital from April 2018 to December 2019 were enrolled;their clinical data were retrospectively analyzed. 128-slice spiral CT was performed before operation, and the diagnostic accuracy and predictive value of 128-slice spiral CT examination for traumatic knee joint recessive fracture were analyzed, and the consistency of the results with surgical confirmation. The consistency of 128-slice spiral CT examination and surgical confirmation results was tested. The distribution of fracture location was counted, and the imaging findings were analyzed. Results According to the surgical diagnosis, 76 of the 83 patients had recessive fractures. The diagnostic rate of 128-slice spiral CT for recessive fractures was 81.58%(62/76). The specificity and sensitivity of 128-slice spiral CT scan in the diagnosis of knee recessive fractures were both high(82.9, 94.3). The Kappa test showed high consistency between 128-slice spiral CT examination and surgical confirmation results(Kappa>0.69). A total of 62 recessive fractures were detected by 128-slice spiral CT, including 86 fracture sites. Fracture sites including proximal tibia, intercondylar eminence, proximal fibula and patella accounted for high proportions. 128-slice spiral CT examination of a recessive fracture of the knee was symbolized by a discontinuity of bone and a lack of anastomosis between displaced and local fractures. Conclusion 128-slice spiral CT is of high diagnostic value for traumatic knee recessive fracture, which can be used in clinical diagnosis.