多层螺旋CT在腕舟骨隐匿性骨折中的诊断价值

Value of multi-slice spiral CT in diagnosis of occult fracture in scaphoid

目的探讨多层螺旋CT在腕舟骨隐匿性骨折中的诊断价值。方法选择2019年12月—2021年8月本院收治的上肢及手外伤所致腕舟骨隐匿性骨折者50例为研究对象,并均通过手术治疗明确存在骨折。所有入组者均结合临床表现与影像学检查结果实施手术治疗,并通过术中所见明确诊断。影像学检查上,其中单纯接受X线检查者为X线片组,多层螺旋CT组则在进行X线片检查后加用多层螺旋CT检查,使用仪器为GE牌64层螺旋CT扫描仪,比较两组对腕舟骨骨折的诊断率,比较两组对不同类型腕舟骨骨折的诊断耗时,比较两组对不同类型腕舟骨骨折的图像评分,比较两组在腕关节隐匿性骨折诊断中的灵敏度、诊断特异度和约登指数,计算AUC值。结果多层螺旋CT组对腕关节腕舟骨隐匿性骨折的诊断率为96.0%,高于X线片组的66.0%(χ^(2)=12.736,P<0.05),多层螺旋CT组对隐匿性A型腕舟骨骨折和隐匿性B型腕舟骨骨折的阅片诊断耗时分别为(5.6±1.4)min和(6.9±1.8)min,均短于X线片组的(12.3±2.5)min和(13.3±1.3)min(t=16.533和20.382,P<0.05),多层螺旋CT组对隐匿性A型腕舟骨骨折和隐匿性B型腕舟骨骨折检查过程中所获得图像真质量的评分分别为(4.2±0.3)分和(4.4±0.2)分,高于X线片组的(3.1±0.2)分和(2.9±0.2)分(t=21.572和37.500,P<0.05),多层螺旋CT在腕关节隐匿性骨折诊断中的灵敏度、诊断特异度和约登指数分别为77.5,71.7和0.656,均高于X线片组的86.7,85.6和0.735,且其诊断AUC值为0.795,明显大于X线片组的0.683。结论针对隐匿性腕舟骨骨折进行多层螺旋CT检查,具有诊断耗时短,图像清晰,诊断价值高等特点。

Objective To explore the clinical value of multi-slice spiral CT in diagnosis of occult fracture of scaphoid.Methods 50 cases of patients suffered from occult fractures on scaphoid that caused by upper limb and hand injuries,those were admitted to our hospital from December 2019 to August 2021,were selected as the research objects,and all of them were confirmed to have fractures through surgical treatment.All the participants were treated by surgery in combination with clinical manifestations and imaging findings,and the diagnosis was made clearly according to intraoperative findings.In imaging examination,those who only received X-ray examination were enrolled in the control group,and those who received multi-slice spiral CT examination after X-ray examination were enrolled in the observation group.The instrument used for CT examination in the observation group was 64-slice spiral CT scanner of GE brand.Then the diagnostic rate of scaphoid fracture between the two groups was compared,the diagnostic time of different types of scaphoid fracture between the two groups was compared,the image scores of different types of scaphoid fracture between the two groups were compared,the sensitivity,diagnostic specificity and Jordan index in the diagnosis of wrist joint concealed fracture between the two groups were compared,and the AUC value was calculated.Results The diagnostic rate of occult scaphoid fracture in wrist joint in multi-slice spiral CT group was 96.0%,which was significantly higher than 66%in X-ray group(χ^(2)=12.736,P<0.05).The scanning time of type A and type B occult scaphoid fracture in multi-slice spiral CT group was(5.6±1.4)min and(6.9±1.1)min,respectively.Both of them were shorter than those of X-ray group(12.3±2.5)min and(13.3±1.3)min(t=16.533 and 20.382,P<0.05).The true quality of images obtained during the examination of type A concealed scaphoid fracture and type B concealed scaphoid fracture in multi-slice spiral CT group were(4.2±0.3)and(4.4±0.2),respectively,the scores were higher than(3.1±0.2)and(2.9±0.2)of X-ray group(t=21.572 and 37.500,P<0.05).The diagnostic sensitivity,specificity and Jordan index of multi-slice spiral CT in the diagnosis of occult wrist fracture were 77.5,71.7 and 0.656,respectively.Which were higher than 86.7,85.6 and 0.735 of X-ray groups.And the diagnostic AUC value was 0.795 in multi-slice spiral CT,which was significantly higher than 0.683 in X-ray group.Conclusions Multi-slice spiral CT examination in diagnosing occult scaphoid fracture has the characteristics of short diagnosis time,clear image and high diagnostic value.