多排螺旋CT对肋骨隐匿骨折及细微骨折的诊断价值

Diagnostic Value of Multi-slice Spiral CT in Occult and Subtle Rib Fractures

目的:分析肋骨隐匿骨折及细微骨折诊断工作中运用64排螺旋CT的诊断效果。方法:选取我院2019年1月一12月接受治疗的90例肋骨隐匿骨折及细微骨折患者,均采取64排螺旋CT检查,首诊为伤后1周,复查为第3、4、6周。结果:(1)所有患者受伤后1周内检查情况,68例(75.56%)单侧肋骨骨折,其中左侧35例,右侧33例;22例(24.44%)双侧肋骨骨折。83例(92.22%)确诊为多发性肋骨骨折,有7例(7.78%)为单发性肋骨骨折。大部分患者影像表现为肋骨骨质断续,断端分离,胸部积液,邻近肋间肌崩肿胀,密度增加,肺不张等骨折形态。(2)伤后2—6周复查发现,肋骨骨折主要发生在骨小梁、肋骨角、肋内缘、肋外缘、肋软骨处。细微性骨折在骨小梁、肋内缘、肋外缘部位的发生率与隐匿性骨折存在明显差异(P<0.05)。结论:隐匿性骨折以及细微性骨折容易发生在骨小梁、肋骨内外缘、肋骨角、肋软骨等位置,临床上采用多排螺旋CT检查时需重视复查,避免漏诊误诊。64排螺旋CT对不同类型肋骨骨折伤中的隐匿骨折及细微骨折具有较高的诊断价值,可推广应用。

Objective:Analyze the diagnostic effect of 64 slice spiral CT in the diagnosis of occult rib fracture and subtle fracture.Methods:90 patients with rib occult fracture and subtle fracture who were treated in our hospital from January 2019 to December 2019 were examined by 64 slice spiral CT.The first diagnosis was 1 week after injury,and the reexamination was 3,4 and 6 weeks.Results:(1)Within one week after injury,68 cases(75.56%)had unilateral rib fracture,including 35 cases on the left and 33 cases on the right;22 cases(24.44%)had bilateral rib fractures.83 cases(92.22%)were diagnosed as multiple rib fractures,and 7 cases(7.78%)were diagnosed as single rib fractures.Most of the patients'images showed bone discontinuity of ribs,separation of broken ends,pleural effusion,collapse and swelling of adjacent intercostal muscles,increased density,atelectasis and other fracture patterns.(2)Reexamination from 2 weeks to 6 weeks after injury found that rib fractures mainly occurred in bone trabecula,rib angle,inner edge of rib,outer edge of rib and costal cartilage.There was a significant difference in the incidence of subtle fractures in trabecula,inner and outer edge of rib and occult fractures(P<0.05).Conclusion:Occult fractures and subtle fractures are easy to occur in bone trabeculae,inner and outer edges of ribs,rib angles,costal cartilage and so on.It is necessary to pay attention to reexamination when using multi-slice spiral CT to avoid missed diagnosis and misdiagnosis.64 slice spiral CT has high diagnostic value in the occult and subtle fractures of different types of rib fractures,and can be widely used.