老年足踝部隐匿性骨折MSCT三维重建、磁共振成像特点及联合诊断价值

MSCT Three-dimensional Reconstruction,Magnetic Resonance Imaging Characteristics and Combined Diagnostic Value of Occult Fracture in the Foot and Ankle in the Elderly

目的研究老年足踝部隐匿性骨折多层螺旋CT(MSCT)三维重建、磁共振成像特点及联合检查的诊断价值,以期为临床早期诊断提供参考依据。方法选取2021年3月—2024年1月收治的120例疑似老年足踝部隐匿性骨折为研究对象,入院后均行MSCT、磁共振成像检查。分析老年足踝部隐匿性骨折的MSCT三维重建、磁共振成像特点。比较MSCT三维重建与磁共振成像检查对老年足踝部隐匿性骨折显示率。比较MSCT三维重建、磁共振成像及联合检查诊断老年足踝部隐匿性骨折的应用价值。结果120例疑似老年足踝部隐匿性骨折中,最终确诊101例,常规X线检查均为阴性,其中外踝撕脱性骨折33例(32.67%)、跟骨前外侧缘骨折26例(25.74%)、距骨骨折19例(18.81%)、内踝骨折8(7.92%)、后踝骨折6例(5.94%)、胫腓骨远端骨折5例(4.95%)、骰骨骨折2例(1.98%)、跖骨近端骨折1例(0.99%)、跟骨体骨折1例(0.99%)。MSCT三维重建影像特点表现为骨折处骨小梁断裂,骨皮质连续性消失,合并有一定程度的骨片撕裂脱落。磁共振成像显示骨髓不规则片状信号,T1WI不规则细线状、条索状低信号,T2WI略高或低信号,脂肪抑制序列高信号或混杂高信号。磁共振成像对骨挫伤/骨髓水肿显示率高于MSCT三维重建(P<0.05)。MSCT三维重建、磁共振成像及联合检查分别检出老年足踝部隐匿性骨折97、95、101例;联合检查的敏感度100.00%(101/101)、准确度100.00%(120/120)高于MSCT三维重建[94.06%(95/101)、93.33%(112/120)]、磁共振成像检查[93.07%(94/101)、93.33%(112/120)],漏诊率为0低于MSCT三维重建5.94%(6/101)、磁共振成像检查6.93%(7/101)(P<0.05)。结论磁共振成像、MSCT三维重建联合检查可有效提高老年足踝部隐匿性骨折诊断准确率,临床可通过该方法进行早期诊断,以制订后续治疗方案。

Objective To study the diagnostic value of multi-slice spiral CT(MSCT)three-dimensional reconstruction,magnetic resonance imaging(MRI)and combined examination in elderly patients with occult fracture of the foot and ankle joint,in order to provide reference for early clinical diagnosis.Methods A total of 120 elderly patients with suspected occult fracture of the foot and ankle joint admitted from March 2021 to January 2024 were selected as the research subjects.MSCT and MRI examination were performed after admission,to analyze the characteristics of MSCT three-dimensional reconstruction and MRI in elderly patients with occult fracture of the foot and ankle joint.The display rate of MSCT three-dimensional reconstruction and MRI in elderly patients with occult fracture of the foot and ankle joint,as well as the application value of MSCT three-dimensional reconstruction,MRI and combined examination in the diagnosis of occult fracture of the foot and ankle joint in the elderly,was compared.Results Of 120 elderly patients with suspected occult fracture of the foot and ankle joint,101 patients were finally diagnosed,and routine X-ray examination was negative.Among them,there were 33(32.67%)patients with avulsion fractures of the external ankle,26(25.74%)with anterolateral border fractures of calcaneus,19(18.81%)with talus fractures,8(7.92%)with medial malleolar fractures,6(5.94%)with posterior malleolar fractures,5(4.95%)with distal tibiofibular fractures,2(1.98%)with cuboid fractures,1(0.99%)with proximal metatarsal fracture and 1(0.99%)with calcaneus fracture.The MSCT three-dimensional reconstruction was characterized by fracture of trabecular bone,loss of cortical bone continuity,and a certain degree of tear and loss of bone fragments.MRI showed irregular bone marrow lamina signal,irregular thin line and cord low signal on T1WI,slightly high or low signal on T2WI,and high or mixed high signal on fat inhibition sequence.MRI showed a higher display rate of bone contusion/bone marrow edema than MSCT three-dimensional reconstruction(P<0.05).MSCT three-dimensional reconstruction,MRI and combined examination detected 97,95 and 101 elderly patients with occult fracture of the foot and ankle joint,respectively.The sensitivity of 100.00%(101/101)and accuracy of 100.00%(120/120)of combined examination were higher than those of MSCT 3D reconstruction[94.06%(95/101),93.33%(112/120)]and MRI[93.07%(94/101),93.33%(112/120)],and the missed diagnosis rate of 0 was lower than that of MSCT 3D reconstruction[5.94%(6/101)]and MRI[6.93%(7/101)](P<0.05).Conclusion The combined examination of MRI and MSCT three-dimensional reconstruction can effectively improve the diagnostic accuracy of occult fracture of the foot and ankle fracture in the elderly,and can be used for early diagnosis and subsequent treatment.