超声和X线平片对膝关节囊内骨折的诊断比较及两种方法联合诊断价值研究  

Diagnostic value of ultrasound and X-ray in the diagnosis of knee intracapsular fracture

作　　者：张光辉[1] 刘旭林[1] 初英萍 盖青竹 徐永忠[1] 潘旭红[1] 王龙江[1] 兰受昌 李忠维[1] 叶天涛 李传红[1] 

机构地区：[1]烟台市烟台山医院影像科,山东省264001

出　　处：《中华临床医师杂志（电子版）》2012年第2期45-49,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：烟台市科学技术发展计划项目(2011235)

摘　　要：目的比较超声和X线平片对膝关节囊内骨折的诊断价值,并研究两种方法联合诊断价值。方法对132例临床疑诊膝关节囊内骨折患者同时进行X线平片检查和超声检查,并以CT(或MRI)检查作为金标准,全部影像检查均在8h内完成。X线平片包括前后位和仰卧水平投照片,制动10min以上摄片。超声检查患者采用仰卧位,探头频率7～12MHz,关节制动时间10min以上。分别统计X线平片和超声显示关节囊内骨折线、积脂血症、以积脂血症作为标准判定关节囊内骨折、以骨折线或积脂血症作为标准判定关节囊内骨折及超声和X线平片联合诊断关节囊内骨折的准确度、敏感度、特异度、阳性预测值、阴性预测值,并进行比较。结果 CT(或MRI)显示骨折组104例,其中60例并存关节积脂血症。非骨折组28例。X线平片检查:骨折组87例见骨折线,17例未见骨折线(隐匿性骨折),48例见积脂血症;非骨折组25例未见骨折线,3例误为骨折(假阳性)。超声检查:骨折组32例见骨折线,72例未见骨折线,其中60例见积脂血症;非骨折组26例未见骨折线,2例误为骨折(假阳性),均未见积脂血症。在17例隐匿性骨折中,平片和超声分别显示积脂血症8例和13例。平片(和超声)显示骨折线的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为84.8%(43.9%)、83.7%(30.8%)、89.3%(92.9%)、96.7%(94.1%)、59.5%(26.5%);平片(和超声)显示积脂血症的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为90.9%(100%)、80.0%(100%)、100%(100%)、100%(100%)、85.7%(100%);以积脂血症作为标准判定关节囊内骨折,X线平片(和超声)的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为57.6%(66.7%)、46.2%(57.7%)、100%(100%)、100%(100%)、33.3%(38.9%)。依据骨折线或积脂血症,X线平片(和超声)诊断膝关节囊内骨折的准确度、敏感度、特异度、阳性预测值、阴性预测值Objective To study the diagnostic value of uhrasouncL and X-ray in the diagnosis of knee intracapsular fracture. Methods 132 cases suspected knee intracapsular fracture were examined by X-ray and ultrasound, CT（ or MRI）to be seemed as gold standard, all the examination were completed within 8 hours. Including anteroposterior and horizontal-beam plain radiograp, and the braking time was more than 10 minutes. Ultrasound examination position was supine. The frequency of the probe was 7-12 MHz. The braking time was more than 10 minutes. We analysed the accuracy, sensitivity, specificity, positive predictive value and negative predictivd value of X-ray and ultrasound respectively by statistics of intracapsular fracture line,lipohemarthrosis, lipohemarthrosis as the standard to assessment knee intracapsular fracture, fracture line or lipohemarthrosis as the standard to assessment knee intracapsular fracture. We analysed the accuracy, sensitivity, specificity, positive predictive value and negativepredictive value of ultrasound with X-ray to diagnosis knee intracapsular fracture. And then compare them. Results There were 104 cases with bone fracture by CT （or MRI）, in which 60 cases with lipohemarthrosis. There were 28 cases without fracture. X-ray：there were 87 cases with fracture line in bone fracture team,in which 17 cases without fracture line（occult fracture）,48 cases with lipohemarthrosis. There were 25 cases without fracture line in non-fracture team,in which 3 cases were falsely diagnosed as bone fracture （false-positive）. Ultrasound：There were 32 cases with fracture line and 72 cases without fracture line in bone fracture team, in which 60 cases with lipohemarthrosis. There were 26 cases without fracture line in non-fracture team, in which 2 cases were falsely diagnosed as bone fracture （ false-positive）, none of them with lipohemarthrosis. There were 17 cases with occult fracture,in which 8 cases with lipohemarthrosis by X-ray and 13 cases with lipohemarthrosis by ultrasound. The diagno

关 键 词：膝关节 骨折 超声检查 放射摄影术 积脂血症 

分 类 号：R816.8[医药卫生—放射医学]