【摘要】 目的探讨多层螺旋CT多向调整多平面重组(MPR)对腕舟状骨隐匿性骨折的诊断价值。方法回顾性分析2010年1月~2013年6月42例腕关节外伤病例,男32例,女10例,年龄19~48岁,平均35.5岁。患者均具有明显外伤史,且临床怀疑腕舟状骨骨折,主要症状为腕关节疼痛,活动受限,局部肿胀,鼻咽窝处有压痛点。数字X线摄影(DR)平片检查阴性12例,舟状骨可疑骨折30例,对所有病例行多层螺旋CT各向同性扫描,再进行多向调整MPR后处理,使骨折在舟状骨的冠状及矢状长轴面上显示,并就其长轴面MPR图像及直接扫描腕关节CT横断面图像在骨折的诊断率上进行对比。结果多层螺旋CT多向调整的长轴面MPR显示12例阴性患者中6例确诊为腕舟状骨骨折,30例可疑骨折均显示舟状骨骨折存在;直接腕关节CT横断面扫描图像显示12例阴性患者中4例确诊为腕舟状骨骨折,30例可疑骨折患者24例显示舟状骨骨折存在。两种检查方法比较腕舟状骨隐匿性骨折的诊断率,差异有统计学意义(P<0.05)。结论多层螺旋CT多向调整的长轴面MPR对腕舟状骨隐匿性骨折具有重要的诊断价值,相比直接腕关节CT横断面扫描检查,可明显提高诊断率。更多还原

【Abstract】 Objective To evaluate the diagnostic value of multi-direction adjusted multiplanar reconstruction( MPR) using multi-slice spiral CT in occult scaphoid fracture. Methods Forty-two patients with wrist trauma from January 2010 to June 2013 were analyzed retrospectively. There were 32 males and 10 females,with an average age of 35. 5 years( range,19 to 48 years).Patients with obvious history of trauma were clinically suspected scaphoid fracture,and the main symptoms were pain,limited wrist joint activities,local swelling,and nasopharyngeal fossa tenderness point. Digital X-ray radiography( DR) were negative in12 cases and suspected scaphoid fracture for 30 cases,and all cases were performed with multi-direction MPR to display long-axial of scaphoid on coronal and sagittal planes. Then,the diagnosing rate was compared between long-axial MPR and direct scanning axial CT images of wrist. Results Multi-direction MPR in long-axial of scaphoid showed that 6 cases were diagnosed with wrist scaphoid fracture in 12 negative cases,and 30 cases of suspected fractures showed the existence of scaphoid fracture. The direct scanning axial CT images of wrist showed that 4 cases diagnosed with wrist scaphoid fracture in 12 negative cases,and 24 cases existed scaphoid fracture in 30 cases of suspected fractures. There were statistically significant between two methods in diagnostic value of occult scaphoid fracture. Conclusion The application of multi-direction adjusted long-axial MPR using multi-slice spiral CT has great value in the diagnosis of occult scaphoid fracture,which can obviously improve the diagnostic rate compared with direct wrist cross-sectional CT scan.更多还原