SPECT联合MSCT在诊断早期隐匿性肋骨骨折中的法医临床学价值

Forensic Clinical Application of SPECT and MSCT in the Forensic Diagnosis of Early Occult Rib Fractures

目的探讨单光子发射计算机断层显像(SPECT)和多层螺旋CT(MSCT)多种重建技术在早期隐匿性肋骨骨折诊断中的法医学应用价值。方法选取51例因胸部外伤怀疑存在隐匿性肋骨骨折的患者行回顾性分析,比较SPECT、MSCT及常规CT、X线在伤后第1~3周、第4~6周内在确诊隐匿性肋骨骨折的差异是否存在统计学意义。结果在伤后第1~3周内,SPECT与MSCT之间存在统计学意义(P<0.05),SPECT、MSCT与常规CT/X线检查之间存在统计学意义(P<0.05)。在伤后第4~6周内,SPECT与MSCT之间的差异不存在统计学意义(P>0.05)。MSCT在伤后第1~3周内与第4~6周之间的差异存在统计学意义(P<0.05);SPECT在伤后第1~3周内与第4~6周之间的差异不存在统计学意义(P>0.05)。结论隐匿性肋骨骨折的最佳复查时间窗为伤后第4~6周,首选MSCT作为复查方式。SPECT具有高灵敏度的优点,与MSCT联合应用可以显著降低漏诊率和误诊率,起到相互补充的作用,在法医临床鉴定中具有重要的应用价值。

Objective To evaluate the forensic application of SPECT and MSCT in the diagnosis of early occult rib fractures.Methods Retrospective analysis was carried out on 51 patients,who were suspected to have occult rib fractures due to chest trauma.The differences of SPECT,MSCT and conventional CT/X-ray in the diagnosis of occult rib fractures in 1-3 weeks and 4-6 weeks after injury were analyzed.Results There was significant difference between SPECT and MSCT in the diagnosis in the first 1-3 weeks after injury(P<0.05).The conventional CT/X-ray examination also had significant difference from SPECT and MSCT(P<0.05).There was no significant difference between SPECT and MSCT in the 4-6 weeks after injury.The difference of diagnosis between 1-3 weeks and 4-6 weeks after injury was statistically different with MSCT(P<0.05),while the diagnosis by SPECT had no significant difference in this two periods.Conclusion The best examination time for identifying occult rib fractures is the 4-6 weeks after injury,and MSCT is recommended for examination.As a highly sensitive technique,SPECT can significantly reduce the rates of missed and misdiagnosis when combined with MSCT.It plays a complementary role,and has important application value in the forensic expertise of clinical medicine.