螺旋CT平扫联合多平面重建在腕舟骨骨折诊断中的应用价值  

Application value of spiral CT scan combined with multiplanar reconstruction in the diagnosis of scaphoid fracture

作　　者：梁吉东 杜晓龙 欧学海 李锦[2] Liang Jidong;Du Xiaolong;Ou Xuehai;Li Jin(Department of Hand Surgery,North Campus of Red Cross Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China;Upper Limb Disease Ward of Center for Sports Medicine Diagnosis and Treatment,North Campus of Red Cross Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院北院区手外科,西安710054 [2]西安交通大学附属红会医院北院区运动医学诊疗中心上肢病区,西安710054

出　　处：《中华解剖与临床杂志》2024年第12期811-815,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨螺旋CT平扫联合多平面重建(MPR)技术在腕舟骨骨折诊断中的应用价值。方法横断面研究。纳入西安交通大学附属红会医院2022年3月—2024年3月经关节镜证实为腕舟骨骨折的88例患者的临床和影像学资料。患者年龄18~45(29.8±3.4)岁,其中男53例、女35例,左侧36例、右侧52例;关节镜检查Herbert骨折分型:C型5例、B1型7例、B2型48例、B3型17例、B4型11例。患者均经螺旋CT扫描,并采用MPR后处理技术处理腕关节图像。以腕关节镜的检查结果作为"金标准",分析螺旋CT平扫以及平扫联合MPR技术对下腕舟骨骨折患者的诊断效能,及其Herbert骨折分型的结果与关节镜检查结果的一致性。结果受试者操作特征曲线分析结果表明,螺旋CT平扫以及平扫联合MPR技术均对腕舟骨骨折具有良好的诊断价值(AUC=0.882、0.989),后者的诊断价值更高(P<0.05)。88例患者经螺旋CT平扫分别检出C型、B1型、B2型、B3型、B4型腕舟骨骨折4、5、38、15、8例,螺旋CT平扫联合MPR技术分别检出5、6、47、18、10例。螺旋CT平扫联合MPR技术检查结果与关节镜检查结果的一致性高于螺旋CT平扫检查结果,Kappa值分别为0.912和0.633。结论螺旋CT平扫联合MPR图像处理技术诊断腕舟骨骨折,检出率较高,对骨折的分型诊断较准确。Objective This study aimed to explore the application value of spiral CT scan combined with multiplanar reconstruction(MPR)in the diagnosis of scaphoid fracture.Methods A cross-sectional study was conducted,using the clinical and imaging data of 88 patients with carpal navicular fracture diagnosed through arthroscopy in the Red Cross Hospital affiliated to Xi'an Jiaotong University between March 2022 and March 2024.The patients were 18-45(29.8±3.4)years old,including 53 males and 35 females.A total of 36 patients were on the left side,and 52 patients on the right side.Herbert fractures were classified through arthroscopy as follows:5 patients with type C,7 patients with type B1,48 patients with type B2,17 patients with type B3,and 11 patients with type B4.All patients underwent spiral CT scan,and wrist images were assessed with an MPR postprocessing technology.The results of wrist arthroscopy as the gold standard were used to analyze the diagnostic efficiency of spiral CT scan,its combination with MPR for scaphoid fracture,and consistency between the two methods and arthroscopy in the diagnosis of Herbert fractures.Results The receiver operating characteristic curves analysis results showed that spiral CT scan alone and in combination with MPR technique had good diagnostic value for scaphoid fracture(AUC=0.882,0.989),and the diagnostic value of combined detection was higher(P<0.05).Spiral CT scan showed that 4,5,38,15,and 8 cases had scaphoid fracture types C,B1,B2,B3,and B4,respectively,whereas Spiral CT scan combined with MPR showed that 5,6,47,18,and 10 cases had scaphoid fracture types C,B1,B2,B3,and B4,respectively.The consistency of spiral CT scan combined with MPR was higher than that of arthroscopy(Kappa=0.912,0.633,respectively).Conclusion Spiral CT scan combined with MPR has a high detection rate of scaphoid bone fractures and can accurately classify them.

关 键 词：舟骨 腕舟骨骨折 体层摄影术 螺旋计算机 多平面重建 诊断价值 

分 类 号：R683.41[医药卫生—骨科学]