Diagnostic value of X-ray and CT combined with MRI in tibial plateau fracture
-
摘要:
目的探讨X线、CT联合MRI在胫骨平台骨折中的诊断价值。 方法回顾性分析我院2017年3月~2019年3月144例(144侧)急诊拟诊胫骨平台骨折患者的临床资料,其中男80例、女64例,年龄20~78岁(52.35±10.49岁);全部患者在常规行X线检查后,依次行CT及MRI检查。比较单独X线诊断、X线联合CT及三者联合诊断的骨折的符合率及对骨折分型诊断的符合率,并探讨各影像学诊断方式在软组织诊断方面的作用。 结果X线+CT两者联合与X线+CT+MRI三者联合诊断胫骨平台骨折符合率比较差异无统计学意义(P>0.05),但均高于单独X线诊断(P<0.05)。X线+CT与三者联合诊断胫骨平台各骨折分析比较差异无统计学意义(P>0.05);X线+CT与三者联合对Ⅰ型、Ⅱ型、Ⅲ型骨折诊断的符合率均高于单独X线诊断,差异有统计学意义(P<0.05)。MRI诊断60例存在软组织损伤,X线及CT未予诊断。 结论X线联合CT对胫骨平台骨折的诊断及分型诊断符合率较高,但进一步联合MRI检查可对软组织损伤情况作出判断,具有较好的应用价值。 Abstract:ObjectiveTo explore the diagnostic value of X-ray and CT combined with MRI in tibial plateau fracture. MethodsThe clinical data of 144 patients (144 sides) with tibial plateau fractures in our hospital from March 2017 to March 2019 were retrospectively analyzed, including 80 males and 64 females with the age from 20 to 78 years old (average 52.35±10.49). All patients were examined by CT and MRI after routine X-ray examination. The coincidence rate of X-ray diagnosis, X-ray combined with CT and three combined diagnoses and the coincidence rate of fracture classification diagnosis were compared. The role of imaging diagnosis methods in soft tissue diagnosis was discussed. ResultsThe difference of the coincidence rate between X-ray+CT and MRI in the diagnosis of tibial plateau fractures was not significant (P>0.05). But the coincidence rate was significantly higher than that of X-ray alone (P<0.05). The difference of the diagnosis of tibial plateau fractures between the two methods and the three methods was not significant (P>0.05). The coincidence rate of the combination of the two and the three in the diagnosis of type I, type II and type III fractures was higher than that of the X-ray diagnosis alone(P<0.05). There were 60 cases of soft tissue injury diagnosed by MRI, but no diagnosis was made by X-ray and CT. ConclusionThe coincidence rate of X-ray combined with CT in the diagnosis and classification of tibial plateau fracture is high, but further combined with MRI examination can make a judgment of soft tissue injury. -
Key words:
- X-ray /
- CT /
- magnetic resonance imaging /
- tibial plateau fracture
-
图 1 患者,男,26岁,车祸致左侧肢体外伤疼痛,活动受限1 h入院查体
左膝部肿胀,未触及骨擦感,,外侧副韧带压痛明显,浮髌征(-),前抽屉试验(+),外翻试验(+),研磨试验(+),左膝关节被动屈伸活动无受限;A, B:X线显示左侧胫骨平台骨折;C, D:CT扫描,检测结果与X线检查一致;E, F:MRI显示前交叉韧带损伤;G, H:MRI显示外侧半月板撕裂.
Figure 1. Patient, male ,26 years old, left limb trauma pain caused by car accident, restricted movement 1 h admission examination
表 1 各组骨折诊断情况(n=144)
Table 1. Fracture diagnosis in each group
诊断方法 确诊 可疑 漏诊 诊断符合率(%) X线 122 8 14 84.72 X线+CT 140 4 0 97.22 X线+CT+MRI 144 0 0 100.00 表 2 不同影像学对各骨折分型诊断符合率 [n(%)]
Table 2. The coincidence rate of different images in the diagnosis of fracture types
分型 X线 X线+CT X线+CT+MRI Ⅰ型(n=24) 13(54.17) 21(87.50)# 24(100.00)# Ⅱ型(n=26) 19(73.08) 26(100.00)# 26(100.00)# Ⅲ型(n=24) 13(54.17) 22(91.67)# 24(100.00)# Ⅳ型(n=20) 14(70.00) 18(90.00) 20(100.00) Ⅴ型(n=34) 34(100.00) 34(100.00) 34(100.00) Ⅵ型(n=16) 16(100.00) 16(100.00) 16(100.00) #P<0.05 vs X线. -
[1] 罗嗣频, 万业达, 张继扬, 等. X线数字断层融合成像在胫骨平台骨折Schatzker分型诊断中的价值[J]. 中华骨科杂志, 2018, 38(11): 675-86. doi: 10.3760/cma.j.issn.0253-2352.2018.11.005 [2] 朱亮旭, 向学凌. 隐匿性胫骨平台骨折患者的CT及MRI影像特征研究[J]. 医学影像学杂志, 2017, 27(9): 1838-40. [3] 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): 137-40. doi: 10.3969/j.issn.1672-5131.2017.07.043 [4] 刘 军, 刘 欢, 王发祥. MSCT与MRI在胫骨平台隐匿性骨折中的诊断价值[J]. 中国骨与关节损伤杂志, 2017, 32(2): 210-1. doi: 10.7531/j.issn.1672-9935.2017.02.034 [5] 徐云钦, 李 强, 申屠刚, 等. 三维CT重建及MRI检查在复杂性胫骨平台骨折中应用的病例对照研究[J]. 中国骨伤, 2012, 25(3): 184-9. [6] 周汇霖. 胫骨平台骨折分型的研究进展[J]. 河北医科大学学报, 2019, 40(9): 1099-3. doi: 10.3969/j.issn.1007-3205.2019.09.028 [7] 安 伟. 在胫骨平台骨折中应用多种影像学的诊断价值[J]. 医学综述, 2012, 18(12): 1922-3, 1938. doi: 10.3969/j.issn.1006-2084.2012.12.047 [8] 孙广江, 姚啸生, 李洪久, 等. X线平片与三维CT检查在胫骨平台骨折评估中的应用价值[J]. CT理论与应用研究, 2016, 25(4): 485-91. [9] 杨瑜玲, 李 鹏. 多层螺旋CT三维重建技术与X线影像学检查在盆骨骨折诊治中应用比较[J]. 中国CT和MRI杂志, 2017, 15(11): 141-3. doi: 10.3969/j.issn.1672-5131.2017.11.043 [10] 吴 昊, 朱玉春, 韩 旭, 等. 多层螺旋CT及其后处理技术在胫骨平台骨折Schatzker分型中应用[J]. 中华实用诊断与治疗杂志, 2015, 29(10): 983-5. [11] 马 腾, 魏代好, 秦 悦, 等. 常规影像学结合3D打印技术在复杂胫骨平台骨折治疗中的应用[J]. 宁夏医科大学学报, 2017, 39(12): 1452-4, 1506. [12] 苏 辉. 隐匿性胫骨平台骨折计算机断层扫描及磁共振成像诊断价值探讨[J]. 影像研究与医学应用, 2017, 1(12): 62-3. doi: 10.3969/j.issn.2096-3807.2017.12.035 [13] 郑彩霞, 邱模良, 孙炎平. 骨折的X线、CT和MRI诊断对比研究[J]. 中国伤残医学, 2013, 32(10): 5-7. doi: 10.3969/j.issn.1673-6567.2013.10.003 [14] Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture[J]. J Orthopaed Trauma, 2017, 31(3): 158-63. doi: 10.1097/BOT.0000000000000762 [15] Sohn H S, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures[J]. J Orthopaed Trauma, 2015, 29(2): 91-7. doi: 10.1097/BOT.0000000000000170 [16] 孙 杰, 卜国云, 孙 杰. 老年人胫骨平台骨折Ⅰ期全膝关节置换的研究进展[J]. 中华创伤杂志, 2018, 34(11): 1051-62. doi: 10.3760/cma.j.issn.1001-8050.2018.11.018 [17] 张毅杰, 强敏菲, 贾小阳, 等. 基于CT三维重建图像的胫骨平台形态学研究及其临床意义[J]. 中华创伤杂志, 2017, 33(1): 63-72. doi: 10.3760/cma.j.issn.1001-8050.2017.01.014 [18] 孙 毅, 耿 磊, 陈 瑶, 等. 隐匿性胫骨平台骨折计算机断层扫描及磁共振成像诊断价值探讨[J]. 中华创伤骨科杂志, 2016, 18(10): 880-4. doi: 10.3760/cma.j.issn.1671-7600.2016.10.010 [19] Dareez NM, Dahlslett KH, Engesland E, et al. Scaphoid fracture: bone marrow edema detected with dual-energy CT virtual non-calcium images and confirmed with MRI[J]. Skeletal Radiol, 2017, 46(12): 1753-6. doi: 10.1007/s00256-017-2730-6 [20] Szopinski K T, Adamczyk P. Interposition of the transverse ligament of the knee into a fracture of the tibial plateau: a case report[J]. Skeletal Radiol, 2018, 47(7): 1011-4. doi: 10.1007/s00256-018-2883-y [21] 王彩红, 唐旦华, 王 健. 三维CT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, 39(4): 581-4. [22] Tosun O, Ocguder A, Annac G, et al. Significant associated MRI findings in patients with anterior cruciate ligament stump entrapment[J]. Skeletal Radiol, 2016, 45(9): 1269-76. doi: 10.1007/s00256-016-2424-5 [23] Warner SJ, Garner MR, Schottel PC, et al. The effect of soft tissue injuries on clinical outcomes following tibial plateau fracture fixation[J]. J Orthopaed Trauma, 2017, 32(3): 1-9.