MSCT重建技术在膝关节骨折诊断中的应用价值
|
摘要
目的应用多层螺旋CT (MSCT)重建技术判断膝关节骨折类型和程度,评价其在膝关节骨折中的诊断价值。方法收集2015年1月至2018年1月间佛冈县人民医院收治的60例膝关节骨折患者的X线片和CT影像资料,分析MSCT多平面重组(MPR)像、最大密度投影(MIP)像、表面遮盖显示(SSD)、容积重建(VRT)对膝关节骨折的显示情况,应用工作者特征曲线(ROC)分析MSCT重建技术在诊断膝关节骨折中的价值。结果 60例患者中,MSCT检出率为93.33%(56/60),X线片检出率为55.00%(33/60),两种方法阳性检出率比较差异有显著统计学意义(P<0.01),而MSCT与X线片在显示内、外髁骨折,股骨髁间骨折方面比较差异均无统计学意义(P>0.05),但MSCT对复杂骨折检出率为45.00%,明显高于X线片的18.33%,差异有显著统计学意义(P<0.01);MPR对膝关节骨折诊断正确率最高(94.12%),其次是SSD (82.22%);以手术解剖所见为金标准,MSCT的工作者特征曲线下面积(AUC)为0.875 (95%CI 0.684～1.967),灵敏度为92%,特异度为89%,准确率为91%。结论 MSCT重建技术可以发现细微膝关节骨折,提高复杂骨折检出率,为临床诊断提供有效参考。
Objective To judge the type and degree of the knee joint fracture with multislice computed tomography(MSCT) reconstruction, and to evaluate its diagnostic value in the knee joint fracture. Methods The X-ray and CT imaging data of 60 patients with knee joint fracture, who admitted to Fogang County People's Hospital from January2015 to January 2018, were collected. The display features of knee joint fracture with MSCT multi planar reconstruction(MPR), maximum intensity projection(MIP), surface shaded display(SSD), volume rendering(VRT) were analyzed.The receiver operating characteristic(ROC) curve was applied to the value of MSCT reconstruction techniques in the diagnosis of knee joint fractures. Results In the 60 cases, the detection rates of MSCT and X-ray were 93.33%(56/60)and 55.00%(33/60), respectively. There was a significant difference between the two methods(P<0.01). There was no statistically significant differences in the internal and external condyle fracture, fracture of femoral condyle between MSCT and X-ray examination(P>0.05), but the detection rate of MSCT was 45.00%, which was significantly higher than 18.33% of X-ray complex fractures(P<0.01). MPR had the highest diagnostic accuracy(94.12%) for knee fracture,followed by SSD(82.22%). Taking surgical anatomy as the gold standard, the area under the characteristic curve(AUC)of MSCT was 0.875(95%CI 0.684 to 1.967), with the sensitivity of 92%, the specificity of 89%, the accuracy rate of91%. Conclusion MSCT reconstruction technique can find fine knee joint fracture, improve the detection rate of complex fracture, and provide effective reference for clinical diagnosis.
Objective To judge the type and degree of the knee joint fracture with multislice computed tomography(MSCT) reconstruction, and to evaluate its diagnostic value in the knee joint fracture. Methods The X-ray and CT imaging data of 60 patients with knee joint fracture, who admitted to Fogang County People's Hospital from January2015 to January 2018, were collected. The display features of knee joint fracture with MSCT multi planar reconstruction(MPR), maximum intensity projection(MIP), surface shaded display(SSD), volume rendering(VRT) were analyzed.The receiver operating characteristic(ROC) curve was applied to the value of MSCT reconstruction techniques in the diagnosis of knee joint fractures. Results In the 60 cases, the detection rates of MSCT and X-ray were 93.33%(56/60)and 55.00%(33/60), respectively. There was a significant difference between the two methods(P<0.01). There was no statistically significant differences in the internal and external condyle fracture, fracture of femoral condyle between MSCT and X-ray examination(P>0.05), but the detection rate of MSCT was 45.00%, which was significantly higher than 18.33% of X-ray complex fractures(P<0.01). MPR had the highest diagnostic accuracy(94.12%) for knee fracture,followed by SSD(82.22%). Taking surgical anatomy as the gold standard, the area under the characteristic curve(AUC)of MSCT was 0.875(95%CI 0.684 to 1.967), with the sensitivity of 92%, the specificity of 89%, the accuracy rate of91%. Conclusion MSCT reconstruction technique can find fine knee joint fracture, improve the detection rate of complex fracture, and provide effective reference for clinical diagnosis.
引文
[1]余坤民,潘斌文.锁定钢板内固定治疗复杂胫骨平台骨折的临床效果观察[J].海南医学, 2012, 23(19):31-33.
[2]唐晓龙,顾敦星.关节镜辅助下微创治疗SchatzkerⅠ~Ⅳ型胫骨平台骨折合并交叉韧带损伤的临床研究[J].海南医学, 2017, 28(7):1161-1163.
[3]孙世毅.多层螺旋CT在膝关节骨折中的应用[J].吉林医学, 2012,33(4):809-810.
[4]姜兵,黄祖平,张伟,等. MSCT重建在四肢关节隐匿性骨折诊断中的应用价值[J].中国现代手术学杂志, 2015, 19(2):150-154.
[5]杨广杰,陈有,王永胜,等.多层螺旋CT三维重建技术在股骨颈骨折手术中应用研究[J].中国CT和MRI杂志, 2017, 15(6):139-141.
[6]李涛,周谋望,侯树勋,等.膝关节骨折患者康复模式的前瞻性多中心研究[J].中国骨与关节杂志, 2016, 5(3):199-204.
[7]李杰,赵云超,马振贤,等.多层螺旋CT及其后处理技术检出隐匿性骨折的诊断价值[J].实用医学杂志, 2016, 32(15):2474-2476.
[8]谢铁明,方临明,邵国良.多层螺旋CT图像重组技术的临床应用进展[J].中国现代医生, 2012, 50(13):21-22, 27.
[9] DE ZWART AD, BEERES FJ, RIETBERGEN DD, et al. Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture[J].Acta Radiologica Open, 2015, 4(10):73-74.
[10]张琛,张丽霞,李杰.多层螺旋CT对老年复杂骨关节骨折的显像效果及分型诊断研究[J].中国CT和MRI杂志, 2017, 15(2):146-148.
[11]曹建新,王一民,孔祥泉,等.双能量CT虚拟去钙图像诊断膝关节外伤性骨髓损伤的应用研究[J].中华放射学杂志, 2014, 48(12):1013-1018.
[12]钟俊,杨法宝,赵学航,等. 64层螺旋CT评价膝关节创伤后的隐匿病变及软组织损伤[J].中国组织工程研究, 2012, 16(30):5604-5608.
[13]陈玉权,吴勇江.多层螺旋CT与MRI对膝关节隐匿性骨折的诊断价值比较[J].实用医院临床杂志, 2017, 14(6):252-254.
[14]王铁才.螺旋CT三维重建在膝关节骨折中的应用[J].中国组织工程研究与临床康复, 2010, 14(52):9841-9844.
[15]杨力,蒲红,朱缨. MSCT扫描及三维重建技术在降低隐匿性骨折漏诊率中的临床应用[J].中国CT和MRI杂志, 2017, 15(7):137-140.
[2]唐晓龙,顾敦星.关节镜辅助下微创治疗SchatzkerⅠ~Ⅳ型胫骨平台骨折合并交叉韧带损伤的临床研究[J].海南医学, 2017, 28(7):1161-1163.
[3]孙世毅.多层螺旋CT在膝关节骨折中的应用[J].吉林医学, 2012,33(4):809-810.
[4]姜兵,黄祖平,张伟,等. MSCT重建在四肢关节隐匿性骨折诊断中的应用价值[J].中国现代手术学杂志, 2015, 19(2):150-154.
[5]杨广杰,陈有,王永胜,等.多层螺旋CT三维重建技术在股骨颈骨折手术中应用研究[J].中国CT和MRI杂志, 2017, 15(6):139-141.
[6]李涛,周谋望,侯树勋,等.膝关节骨折患者康复模式的前瞻性多中心研究[J].中国骨与关节杂志, 2016, 5(3):199-204.
[7]李杰,赵云超,马振贤,等.多层螺旋CT及其后处理技术检出隐匿性骨折的诊断价值[J].实用医学杂志, 2016, 32(15):2474-2476.
[8]谢铁明,方临明,邵国良.多层螺旋CT图像重组技术的临床应用进展[J].中国现代医生, 2012, 50(13):21-22, 27.
[9] DE ZWART AD, BEERES FJ, RIETBERGEN DD, et al. Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture[J].Acta Radiologica Open, 2015, 4(10):73-74.
[10]张琛,张丽霞,李杰.多层螺旋CT对老年复杂骨关节骨折的显像效果及分型诊断研究[J].中国CT和MRI杂志, 2017, 15(2):146-148.
[11]曹建新,王一民,孔祥泉,等.双能量CT虚拟去钙图像诊断膝关节外伤性骨髓损伤的应用研究[J].中华放射学杂志, 2014, 48(12):1013-1018.
[12]钟俊,杨法宝,赵学航,等. 64层螺旋CT评价膝关节创伤后的隐匿病变及软组织损伤[J].中国组织工程研究, 2012, 16(30):5604-5608.
[13]陈玉权,吴勇江.多层螺旋CT与MRI对膝关节隐匿性骨折的诊断价值比较[J].实用医院临床杂志, 2017, 14(6):252-254.
[14]王铁才.螺旋CT三维重建在膝关节骨折中的应用[J].中国组织工程研究与临床康复, 2010, 14(52):9841-9844.
[15]杨力,蒲红,朱缨. MSCT扫描及三维重建技术在降低隐匿性骨折漏诊率中的临床应用[J].中国CT和MRI杂志, 2017, 15(7):137-140.