CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用

摘要 目的：探讨电子计算机断层扫描(Computed Tomography，CT)与磁共振成像(Magnetic resonance imaging，MRI)扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用。方法：2016年9月到2019年10月选择在本院诊治的下拟诊为四肢骨关节隐匿性骨折118例，所有患者都给予CT与MRI扫描三维重建诊断，记录影像学特征与判断诊断价值。结果：在118例患者中，最终确诊为四肢骨关节隐匿性骨折98例，无骨折20例，其中腕关节骨折34例，踝关节骨折22例，膝关节骨折15例，肘关节骨折15例，肩关节骨折8例，髋关节骨折4例。在98例确诊的四肢骨关节隐匿性骨折中，MRI三维重建显示双边征、骨质破坏、充气征、软组织影等比例显著都高于CT (P<0.05)。CT与MRI三维重建诊断四肢骨关节隐匿性骨折的敏感性为89.8 %和99.0 %，特异性为95.0 %和100.0 %，误诊率分别为9.3 %和0.8 %，MRI三维重建诊断的敏感性高于CT ，漏诊率低于CT。结论：CT与MRI扫描三维重建在四肢骨关节隐匿性骨折诊断中的应用都有很好的价值，特别是MRI三维重建能清晰显示骨折特征，具有更高的诊断敏感性，能减少漏诊率，可作为四肢骨关节隐匿性骨折的首选检查方法。

Application of CT and MRI Scan Three-dimensional Reconstruction in the Diagnosis of Occult Fractures of Extremities

ABSTRACT Objective: To investigate the application of CT and magnetic resonance imaging(MRI) three-dimensional reconstruction in the diagnosis of occult fractures of the extremities. Methods: From September 2016 to October 2019, 118 patients with occult fractures of the extremities were selected as the study subjects. All patients were underwent CT and MRI scan three-dimensional reconstruction diagnosis, recorded the imaging features and were to determine the diagnostic values. Results: There were 98 patients were diagnosed as occult fractures of extremities in the 118 patients that included 34 patients with wrist fractures, 22 patients with ankle fractures, 15 patients with knee fractures, and 15 patients with elbow fractures, 8 patients with shoulder fracture and 4 patients with hip fracture. In the 98 patients of occult fractures of the extremities, MRI three-dimensional reconstruction showed that the bilateral signs, bone destruction, aeration sign, soft tissue shadows were significantly higher than CT(P<0.05). The sensitivity of CT and MRI three-dimensional reconstruction in the diagnosis of occult fractures of the extremities were 89.8 % and 99.0 %, the sensitivity were 95.0 % and 100.0 %, and the misdiagnosis rates were 9.3 % and 0.8 %, respectively. The sensitivity of MRI three-dimensional reconstruction diagnosis were higher than the CT, the rates of missed diagnosis were lower than that of CT. Conclusion: Three-dimensional reconstruction of CT and MRI scans are of great values in the diagnosis of occult fractures of the extremities. In particular, MRI three-dimensional reconstruction can clearly show the fracture characteristics, have higher diagnostic sensitivity, and can reduce the rate of missed diagnosis that can be used as the first choice for occult fractures of the extremities.