急性膝关节损伤的X线与CT对比分析和研究

A comparative analysis of X-ray and CT in acute injury of knee joint: analysis of 60 cases

目的分析急性膝关节损伤的CT征象,评价CT在急性膝关节损伤诊断中的应用价值和局限性。方法60例膝关节外伤患者进行X线、薄层CT及三维重建检查,并进行对照分析。结果CT显示60例患者中共有膝关节骨折141处,X线显示骨折104处。普通X线及CT的检出率差异有非常显著性意义(χ2=38.12,P<0.01);CT诊断浮膝骨折44例,X线诊断浮膝骨折38例,占86%;32例胫骨平台骨折中,10例X线片未能显示平台塌陷和骨折,因而分型上与CT不一致。在CT和X线片上分别对平台骨折塌陷距离和骨折劈裂距离进行测量,两数值比较差异有非常显著性意义(平台塌陷:t1=2.35,劈裂移位t2=2.13,均P<0.05)。CT诊断与手术符合的8例半月板损伤,X线均不能显示;CT诊断十字韧带损伤15例,X线诊断9例,有6例因未见韧带附着处的撕脱骨折而漏诊;CT诊断侧副韧带损伤27例,X线应力像诊断19例。本组CT示关节腔积血22例,积气5例,其中脂血征7例。X线片示关节腔积液13例,积气2例,未见脂血征。结论在急性膝关节损伤中,CT能安全、快捷地对骨折脱位、外伤性半月板损伤、十字韧带损伤、侧副韧带损伤、膝关节腔内积气、积血、脂血征、关节损伤的稳定性等作出全面、准确的诊断。但是CT仍存在局限性,只有CT与X线检查相结合才能提高诊断水平,为临床制定治疗方案提供可靠依据。

Objective To analyse the CT findings of acute knee joint injury (AKJI) so as to evaluate the value and limitation of CT in the diagnosis of AKJI. Methods Sixty cases of AKJI were examined with X-ray plain film and thin-section of CT scanning, while three-dimensional reconstruction of CT was performed routinely as well. The results of X-ray films and CT scanning were analysed and compared with clinical data and operative findings retrospectively. Results In 60 cases of AKJI, 141 fractures were found on CT examination, however, only 104 fractures were found on X-ray films. The difference of the results between the two diagnostic imagings was statistically significant(χ2=38.12, P<0.01); Forty-four cases were detected as floating knee injury, but only 38 cases (86%) were detected by X-ray examination; In 10 of 32 cases of fracture of tibial plateau, collapse and fracture of tibial plateau could not be found by X-ray, so that the typing of the fractures was different between CT and X-ray classifications. The collapsed extent and cleavage distance of the tibial fracture were measured depending on CT and X-ray films respectively, the results were statistically analysed, t1 value of collapsed fracture was 2.35, while t2 value of cleavage distance of fracture was 2.13, both of two values were significant different statistically. By CT scanning, 8 cases were accompanied with meniscus injury which was confirmed by operation, but X-ray overlooked the meniscus injury. Fifteen cases of cruciate ligaments injury of knee joint were diagnosed by CT, while 9 cases of whom were positive and 6 cases were negative as diagnosed by X-ray because the fractured bone on which the ligaments attached were not easily found by X-ray. Twenty-seven cases of collateral ligaments injury of knee joint were diagnosed by CT, but X-ray stress imagings suggested only 19 cases associated with the injury. CT examination showed 22 cases of hemarthrosis of knee joint, there were 7 cases with lipemia, and CT also displayed 5 cases of articular cavity pneumatosis. X-ray only showed 13 cases hemarthrosis of knee joint and 2 cases of articular cavity pneumatosis. Conclusion For the patient with AKJI, CT scanning could demonstrate the fracture, displacement, meniscus injury, cruciate ligaments injury, collateral ligaments injury, hemarthrosis, lipemia, articular cavity pneumatosis and the stability of knee joint more precisely than X-ray. But the combination of X-ray examination with CT scanning is able to raise the diagnostic level and provide the reliable basis for clinical treatment because of the some limitations of CT to disclose the full view of the injury.