64排螺旋CT对肋骨隐匿骨折及细微骨折的诊断价值  

The diagnostic value of 64-slice spiral CT in the location of occult fractures and tiny fractures

作　　者：郑志峰[1] 胡杰[1] 袁亚琴[1] 徐丽梅[2] 王书行[1] ZHENG Zhifeng;HU Jie;YUAN Yaqin(Department of CT,The Third Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市第三医院CT室,050000 [2]河北省中医院美容科

出　　处：《河北医药》2019年第2期263-265,共3页Hebei Medical Journal

摘　　要：目的研究64排螺旋CT对肋骨隐匿骨折及细微骨折好发部位的诊断价值。方法 100例行64排螺旋CT检查的肋骨隐匿骨折及细微骨折患者。首次CT检查在骨折发生1周内,后期以每周为单位进行CT复查,并以薄层骨算法重建图像为基础,结合容积再现(VR)、曲面重组(CPR)等各种后处理技术,对患者不同时期复查新检出骨折的发生情况及发生部位进行分析。结果 100例患者在伤后1周首次行CT检查,共检出骨折594根。所有患者获得至少6周的随访复查,有29例多次复查与首次检查存在差异,纳入到差异组。差异组在第3、4、6周复查时新检出隐匿性骨折分别为16、28、8根。统计显示,隐匿性肋骨骨折好发于骨小梁、肋骨角及肋内/外缘,细微性肋骨骨折好发于肋骨角、肋内/外缘及肋软骨处。隐匿性骨折与细致性骨折在骨小梁、肋内缘、肋外缘的骨折发生率比较,差异有统计学意义(P <0. 05)。结论骨小梁、肋骨内外缘、肋骨角、肋软骨等部位易发生隐匿性及细微性骨折,临床需着重加强上述部位的CT检查,并在伤后2～4周内注意复查,以减少误诊漏诊率。Objective To evaluate the value of 64 row spiral CT in the diagnosis of occult fracture and the location of tiny fracture.Methods A total of 100 patients with occult rib fractures and tiny fractures who underwent 64-slice spiral CT examination in our hospital from March 2015 to December 2017 were enrolled in the study.The first CT examination was performed within one week after the fracture,then the CT reexamination was performed weekly,moreover,based on the reconstructed thin-layer images and various post-processing techniques such as VR(volume rendering)and CPR(curved surface reconstruction),the occurrence status of newly detected fractures at different periods and injury position were analyzed.Results One hundred patients underwent CT examination for the first time at 1 week after injury,and a total of 594 fractures were detected.All the patients received follow up at least 6 weeks.There were differences between the first examination results and multiple reexamination resulta in 29 patients,who were enrolled as difference group.In the 3th,4th,and 6th week,the newly detected occult fractures in difference group were 16,28,8,respectively.The results showed that the occult rib fractures often occured in the trabecular bone,rib angle and ribs/outer edge,however,the fine rib fractures often occured in the rib angle,ribs/outer edge and costal cartilage.There were significant differences in the incidence rates of different fracture position between occult fractures and tiny fractures(P<0.05).Conclusion The trabecular,internal and external ribs,ribs angle,costal cartilage are easy to occur occult fracture and tiny fractures.It is necessary to strengthen the CT examination in the positions mentioned above,and to pay much attention to the reexamination within 2~4 weeks after injury,so as to reduce the rate of misdiagnosis rate and missed diagnosis rate.

关 键 词：肋骨隐匿骨折 肋骨细微骨折 螺旋CT 好发部位 诊断价值 

分 类 号：R683.1[医药卫生—骨科学]