基层医院膝关节外伤MSCT检查的临床应用价值
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摘要
目的探讨基层医院膝关节外伤多层螺旋CT(Multi Slice Helical CT,MSCT)的应用价值。方法收集2016年1月至2018年9月我院诊治疑膝关节骨折的病例60例,通过MSCT检查后,利用后处理重建,调节适当的窗宽、窗位、限制膝关节各组成骨折(包括微小骨折)、韧带损伤、半月板损伤、关节积液或积血、软组织挫伤情况等,进行膝关节骨折的分型,与外科手术病理结果对照,计算诊断准确率、敏感性、阳性预测值、阴性预测值。结果 60例膝关节外伤患者中,Schatzker分型法Ⅰ型10例,Ⅱ型12例,Ⅲ型16例,Ⅳ型5例,Ⅴ型8例,Ⅵ型9例;X射线平片漏诊8例,其骨折准确率89.3%,MSCT准确率为100%,采用MSCT检查后纠正分型12例;与CPR、VR、SSD、MIP比较,任意面重建(MPR)的和特异度(93.6%)、灵敏度(88.5%)、阳性预测值(96.5%)和阴性预测值(78.6%)均较高,差异有统计学意义(P<0.05),MSCT结果与手术病理显示率比较,差异无统计学意义(P>0.05)。结论采用多层螺旋CT检查膝关节外伤,可提供更准确、清晰的影像信息,对明确临床诊断及治疗具有良好的指导意义。
Objective To explore the value of Multi Slice Helical CT(MSCT) in primary knee injury. Methods Sixty cases of suspected knee joint fractures were collected from January 2016 to September2018 in our hospital. After MSCT examination, post-treatment reconstruction was used to adjust the appropriate window width and window level to limit the fractures of the knee joint(including the tiny Fractures), ligament injury, meniscus injury, joint effusion or hemorrhage, soft tissue contusion and so on, the type of knee joint fracture was compared with the surgical pathological results to calculate the diagnostic accuracy, sensitivity, positive predictive value, negative Predictive value. Results Among the 60 cases of knee trauma, there were 10 cases of type Ⅰ, 12 cases of type Ⅱ, 16 cases of type Ⅲ, 5 cases of type Ⅳ, 8 cases of type Ⅴ and 9 cases of type Ⅵ. There were 8 cases of missed diagnosis of X-ray, The accuracy of MSCT was 89.3%, the accuracy of MSCT was100%, and 12 cases were corrected by MSCT. The sensitivity and specificity of MPR were88.5% and 93.6% respectively, the positive predictive value was 96.5% and the negative predictive value was 78.6%, which was higher than that of CPR,VR,SSD and MIP(P<0.05). There was no significant difference between MSCT and surgical pathology(P>0.05). Conclusion Multi-slice spiral CT examination of knee injury, can provide more accurate and clear image information, the clear clinical diagnosis and treatment has a good guiding significance.
Objective To explore the value of Multi Slice Helical CT(MSCT) in primary knee injury. Methods Sixty cases of suspected knee joint fractures were collected from January 2016 to September2018 in our hospital. After MSCT examination, post-treatment reconstruction was used to adjust the appropriate window width and window level to limit the fractures of the knee joint(including the tiny Fractures), ligament injury, meniscus injury, joint effusion or hemorrhage, soft tissue contusion and so on, the type of knee joint fracture was compared with the surgical pathological results to calculate the diagnostic accuracy, sensitivity, positive predictive value, negative Predictive value. Results Among the 60 cases of knee trauma, there were 10 cases of type Ⅰ, 12 cases of type Ⅱ, 16 cases of type Ⅲ, 5 cases of type Ⅳ, 8 cases of type Ⅴ and 9 cases of type Ⅵ. There were 8 cases of missed diagnosis of X-ray, The accuracy of MSCT was 89.3%, the accuracy of MSCT was100%, and 12 cases were corrected by MSCT. The sensitivity and specificity of MPR were88.5% and 93.6% respectively, the positive predictive value was 96.5% and the negative predictive value was 78.6%, which was higher than that of CPR,VR,SSD and MIP(P<0.05). There was no significant difference between MSCT and surgical pathology(P>0.05). Conclusion Multi-slice spiral CT examination of knee injury, can provide more accurate and clear image information, the clear clinical diagnosis and treatment has a good guiding significance.
引文
[1]王亮. M R I在膝关节隐匿性骨折诊断中的应用[J].中国老年学志,2014,34(10):2737-2738.
[2]黄继宗,赵仕懂,丘武应,陈志武, M S C T扫描在胫骨平台骨折诊断价值[J].现代医用影像学,2017,27(5):1680-1682.
[3]石少林,费俊贻,冯朝阳,等.外伤性膝关节隐性骨折的磁共振成像诊断价值[J].实用医技杂志,2014,9(9):961-962.
[4]郑晓娜,付馨,吴耀贤,等.3.0TMRI多序列成像在膝关节创伤中的应用[J].河南外科学杂志,2014,20(4):25-27.
[5]刘振江,杨秋娟,刘和波,等.低场MRI对创伤性膝关节积脂血症的诊断价值[J].中国伤残医学,2014,22(17):58-59.
[6]于洋,王建华.多层螺旋CT扫描在胫骨平台粉碎性骨折诊断中的应用[J].中国CT和MRI杂志,2016,14(7):127-136.
[7]袁涛,马彪,米学伟,等.DR与多层螺旋CT三维重建技术在肋骨骨折诊断中的对比应用[J].解放军医药杂志,2013,8(12):14-17.
[8]刘禄明,郑雷,都基权,等.64层螺旋CT诊端Lisfranc关节损伤的临床应用价值[J].医学影像学杂志,2013,23(2):285-286.
[9]王彩红,唐旦华,王健.三维C T重建及MRI在复杂性胫骨平台骨折中的诊断价值[J].医学影像学杂志,2014,24(4):581-584.
[10]赵国权,尹虎,冯琳,等.多层螺旋C T容积扫描在足部外伤诊断中的应用[J].临床军医杂志,2012,40(15):1269-1270.
[11]徐方元.多层螺旋C T后处理技术在胫骨平台骨折诊断中的应用价值[J].医学影像杂志,2013,23(1):120-123.
[12]Phelan N.Rowland P.,Galvin R.,etal.Asystematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee[J].Knee Surg Sports Traumatol Arthrosc,2016,24(5):1525-1539.
[13]郭继录.骨挫伤及隐匿骨折的低场M R诊断[J].中国医药指南,2013,11(3):149-150.
[2]黄继宗,赵仕懂,丘武应,陈志武, M S C T扫描在胫骨平台骨折诊断价值[J].现代医用影像学,2017,27(5):1680-1682.
[3]石少林,费俊贻,冯朝阳,等.外伤性膝关节隐性骨折的磁共振成像诊断价值[J].实用医技杂志,2014,9(9):961-962.
[4]郑晓娜,付馨,吴耀贤,等.3.0TMRI多序列成像在膝关节创伤中的应用[J].河南外科学杂志,2014,20(4):25-27.
[5]刘振江,杨秋娟,刘和波,等.低场MRI对创伤性膝关节积脂血症的诊断价值[J].中国伤残医学,2014,22(17):58-59.
[6]于洋,王建华.多层螺旋CT扫描在胫骨平台粉碎性骨折诊断中的应用[J].中国CT和MRI杂志,2016,14(7):127-136.
[7]袁涛,马彪,米学伟,等.DR与多层螺旋CT三维重建技术在肋骨骨折诊断中的对比应用[J].解放军医药杂志,2013,8(12):14-17.
[8]刘禄明,郑雷,都基权,等.64层螺旋CT诊端Lisfranc关节损伤的临床应用价值[J].医学影像学杂志,2013,23(2):285-286.
[9]王彩红,唐旦华,王健.三维C T重建及MRI在复杂性胫骨平台骨折中的诊断价值[J].医学影像学杂志,2014,24(4):581-584.
[10]赵国权,尹虎,冯琳,等.多层螺旋C T容积扫描在足部外伤诊断中的应用[J].临床军医杂志,2012,40(15):1269-1270.
[11]徐方元.多层螺旋C T后处理技术在胫骨平台骨折诊断中的应用价值[J].医学影像杂志,2013,23(1):120-123.
[12]Phelan N.Rowland P.,Galvin R.,etal.Asystematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee[J].Knee Surg Sports Traumatol Arthrosc,2016,24(5):1525-1539.
[13]郭继录.骨挫伤及隐匿骨折的低场M R诊断[J].中国医药指南,2013,11(3):149-150.