腕骨脱位的X线平片及40层螺旋CT诊断比较  

Diagnostic comparison of X-ray plain film and 40-multidetector CT in dislocation of carpal bones

作　　者：于宝江[1] 曹立福 骈文婷[1] 郭健[1] 宋伟兴[1] 白振武 

机构地区：[1]天津港口医院放射科,300456 [2]中交天津航道局门诊部

出　　处：《国际医学放射学杂志》2012年第3期216-219,共4页International Journal of Medical Radiology

摘　　要：目的探讨腕骨脱位X线平片及多层螺旋CT的影像学表现,并对两者的检出情况进行比较,以提高对腕骨脱位的诊断水平,减少漏诊误诊。资料与方法对2006年8月—2009年11月共21例腕骨脱位病人的X线平片、多层螺旋CT薄层扫描及容积再现（VR）三维重组和多平面重组（MPR）影像进行回顾性分析。其中男19例,女2例,年龄19~45岁,平均（31±7）岁。腕骨脱位位于左侧14例,右侧7例。结果月骨脱位8例;月骨周围型脱位13例,其中,单纯月骨周围型脱位3例,经舟状骨月骨周围脱位4例,经舟状骨、三角骨月骨周围脱位1例,经三角骨月骨周围脱位3例,经桡骨茎突月骨周围性脱位2例。在伴有其他腕骨骨折的病例中,桡骨茎突及舟骨骨折于X线平片均得到确诊,而3例合并三角骨骨折的病例在X线平片上或不能显示骨折,或显示骨折片但不能确定具体部位。运用螺旋CT薄层扫描及重组后均做出了正确诊断。结论 X线平片对于腕骨脱位大多可以做出正确诊断,但当合并腕骨骨折,特别是细微骨折时,漏诊率较高,多层螺旋CT的MPR、VR技术可全面、准确地显示腕骨脱位及合并骨折情况,具有较高的临床应用价值。Objective To study the imaging manifestations and detecting rates of dislocation of carpal bones on X-ray plain film and 40-multidetector CT（MDCT）,to improve the diagnostic accuracy and to reduce the missed diagnosis and misdiagnosis.Materials and Methods The X-ray plain films,MDCT,volume rendering（VR） and multiplanar reconstruction（MPR） of 21 patients with dislocation of carpal bones were retrospectively studied.19 cases were male and two were female,mean age 31±7 years old（19-45 years）.Dislocation was in left side in 14 cases,in right in seven cases.Result Eight cases of lunate dislocation,13 cases of perilunar dislocation,three cases of simple perilunar dislocation,four cases of perilunar dislocation per navicular bone,One case of perilunar dislocation per navicular and triangular bones,three cases of perilunar dislocation per triangular bones,two cases of perilunar dislocation per styloid process of radius.Among the cases with fracture of other carpal bones,the diagnosis of fractures of radial styloid process and navicular bones were correctly detected on X-ray plain film.But in three cases with fracture of triangular bone,the fractures were indetectable or the original place of the bone fragments were unable to determine on X-ray plain film.but could be correctly detected with MDCT and reconstruct technology.Conclusion Diagnosis of dislocation of carpal bones can be correctly made with X-ray plain film in the most cases.But for the cases with fracture of carpal bones,especially with tiny fracture,X-ray plain film produces high rate of missed diagnosis.MDCT,VR and MPR can accurately show dislocations and fractures in three-dimension having high clinical value.

关 键 词：腕骨X线平片 重建 诊断 脱位 

分 类 号：R734.2[医药卫生—肿瘤]