【摘要】 目的 总结肋骨隐匿性骨折(ORF)的影像学特征，分析ORF漏诊、误诊的原因，探讨提高ORF检出率的对策。方法 选取行多层螺旋CT(MSCT)的142例肋骨骨折患者，首次检查在伤后1周内，并在伤后1周后进行多时间复查，回顾性分析患者复查期间检出骨折情况和发生部位，观察青年组(17例)、中年组(64例)与老年组(61例)骨折边缘硬化或骨痂生长时间。结果 肋骨前段是隐匿性骨折好发部位，有199处(53.4%)。近肋软骨段及肋骨后段的骨折漏诊率较高，漏诊率分别为49.4%、58.8%。与首次检查显示的肋骨骨折数量对比，伤后第3～6周肋骨骨折数量差异有统计学意义(P<0.05)。青年组、中年组、老年组骨折后局部硬化或骨痂生长时间分别为(18.76±3.849) d、(26.14±6.597) d、(37.69±5.726) d,组间比较差异有统计学意义(P<0.05)。结论 MSCT在伤后短期内诊断ORF存在一定的限度，重点观察隐匿性骨折好发部位及漏诊部位，系统认知ORF的影像学特征。对不同年龄组患者采取最佳检出时间窗，可降低ORF漏诊率和误诊率，提高骨折检出率，从而为临床及法医学鉴定提供准确客观依据，具有重要的临床意义和应用价值。更多还原

【Abstract】 Objective To summarize the imaging characteristics of occult rib fracture(ORF),analyze the causes of missed diagnosis and misdiagnosis of ORF,and explore strategies to improve the detection rate of ORF.Methods A total of 142 patients with rib fractures who underwent multi spiral computed tomography(MSCT) were selected.The initial examination was conducted within 1 week after the injury,and follow-up examinations were performed at multiple time points after 1 week post-injury.A retrospective analysis was conducted to review the fracture detection and locations during the follow-up period.The time of fracture edge sclerosis or callus growth was observed in the young group(17 cases),middle-aged group(64 cases),and elderly group(61 cases).Results The anterior segment of the ribs was the predilection site for occult fractures,with 199 cases(53.4%).The missed diagnosis rates of fracture were higher for fractures near the costal cartilage segment and the posterior segment of the ribs,with missed diagnosis rates of 49.4% and 58.8%,respectively.Compared with the number of rib fractures identified in the initial examination,there was a statistically significant difference in the number of rib fractures at 3-6 weeks after injury(P<0.05).The time of local sclerosis or callus growth in the young,middle-aged and elderly groups was(18.76±3.849) d,(26.14±6.597) d,and(37.69±5.726) d,respectively,with statistically significantl differences between the groups(P<0.05).Conclusion MSCT has certain limits in diagnosing ORF in the short term after injury.Primarily observing the predilection sites and missed sites of occult fractures,systematically recognizing the imaging characteristics of ORF,and adopting the optimal detection-time window for patients of different age groups can reduce the missed diagnosis rate and misdiagnosis rate of ORF and improve the detection rate of fractures.This provides accurate and objective basis for clinical and forensic identification,with significant clinical importance and application value.更多还原