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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 211 -216. doi: 10.3877/cma.j.issn.2096-0263.2022.04.004

骨科影像

核磁共振联合多层螺旋CT对下肢隐匿性骨折的临床诊断效果分析
李云广, 熊亮†(), 敖锋   
  1. 442000　十堰市人民医院（湖北医药学院附属人民医院）脊柱外科
    442000　十堰市人民医院（湖北医药学院附属人民医院）放射科
    442000　十堰市人民医院（湖北医药学院附属人民医院）放射影像中心
  • 收稿日期:2021-05-26 出版日期:2022-08-05
  • 通信作者: 熊亮
  • 基金资助:
    湖北省卫生健康委员会科研项目(WJ2019M050)

Analysis of the clinical diagnosis effect of MRI combined with multi-slice spiral CT in the occult fracture of lower limbs

Yunguang Li, Liang Xiong†(), Feng Ao   

  1. Department of Spinal Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
    Department of Radiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
    Department of Radiographic Imaging Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
  • Received:2021-05-26 Published:2022-08-05
  • Corresponding author: Liang Xiong
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李云广, 熊亮, 敖锋. 核磁共振联合多层螺旋CT对下肢隐匿性骨折的临床诊断效果分析[J]. 中华老年骨科与康复电子杂志, 2022, 08(04): 211-216.

Yunguang Li, Liang Xiong, Feng Ao. Analysis of the clinical diagnosis effect of MRI combined with multi-slice spiral CT in the occult fracture of lower limbs[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(04): 211-216.

目的

探讨核磁共振联合多层螺旋CT对下肢隐匿性骨折的临床价值。

方法

选取2016年10月至2018年10月本院接收的X检查为阴性且确诊为隐匿性骨折患者324例，对比核磁共振、多层螺旋CT、两者联合诊断三种方法对下肢隐匿性骨折的检出情况，观测诊断方法的影像图，评价诊断效能。

结果

共纳入300例患者，均完成MRI检查和MSCT三维成像检查，MRI检出246处骨折，MSCT检出378处骨折，MRI联合MSCT检出402处骨折。三种诊断方法在8种类型骨折的诊断方面并不具备显著的统计学意义。衰竭骨折和疲劳骨折二者联合诊断的敏感度和准确率显著高于MSCT诊断相应值，且疲劳骨折MRI诊断的敏感度显著高于MSCT诊断相应值。隐性创伤骨折和隐性骨内骨折二者联合诊断的敏感度和准确率显著高于MSCT诊断相应值，隐性创伤骨折二者联合诊断的敏感度显著高于MRI诊断相应值。隐性骨内骨折MRI诊断的敏感度显著高于MSCT诊断相应值。

结论

核磁共振联合多层螺旋CT对下肢隐匿性骨折具有更高的诊断效能，为后续治疗方案的制定提供参考意见。

关键词: 诊断效能, 磁共振成像, MSCT, 隐匿性骨折
Objective

To investigate the clinical value of magnetic resonance imaging (MRI) combined with multi-slice spiral CT in the diagnosis of occult fracture of lower limbs.

Methods

From October 2016 to October 2018, 324 patients with X-ray examination negative and diagnosed as occult fracture in our hospital were selected. The detection of lower limb occult fracture by MRI, multi-slice spiral CT and their combined diagnosis methods were compared, and the image of diagnostic methods was observed to evaluate the diagnostic efficiency.

Results

All 300 patients completed MRI and MSCT three-dimensional imaging examination. 246 fractures were detected by MRI, 378 fractures by MSCT, and 402 fractures were detected by MRI combined with MSCT. The three diagnostic methods did not have significant statistical significance in the diagnosis of 8 types of fractures. The sensitivity and accuracy of combined diagnosis of failure fracture and fatigue fracture were significantly higher than that of MSCT, and the sensitivity of MRI diagnosis of fatigue fracture was significantly higher than that of MSCT. The sensitivity and accuracy of combined diagnosis of recessive traumatic fracture and recessive intraosseous fracture were significantly higher than those of MSCT, and the sensitivity of combined diagnosis of recessive traumatic fracture was significantly higher than that of MRI. The sensitivity of MRI was significantly higher than that of MSCT.

Conclusion

MRI combined with multi-slice spiral CT has a higher diagnostic efficiency for the occult fracture of lower limbs, which can provide reference for the formulation of follow-up treatment plan.

Key words: Diagnostic efficacy, Magnetic resonance imaging, MSCT, Occult fracture
图1 研究对象的纳入和排除标准
表1 研究对象的基本情况[例/%，±s]
类型 病例数 类型 病例数
男性 204/68.00 疲劳骨折 68/22.67
女性 96/32.00 衰竭骨折 52/17.33
年龄/岁 45.95±6.24 隐匿创伤骨折 72/24.00
病程/天 7.2±0.8 隐匿骨内骨折 108/36.00
韧带损失 66/22.00 交通事故 198/66.00
半月板软骨损伤 120/40.00 重物砸伤 48/16.00
骨髓水肿 126/42.00 跌落伤 30/10.00
关节面软骨水肿和破损 138/46.00 高空坠物 18/6.00
关节腔液 234/78.00 不明原因 3/1.00
图2~5 膝关节隐匿性骨折的MRI扫描结果
图6~11 男，46岁，患者通过MSCT图像确诊为左右胫骨平台骨折。图6和图7　MSCT图像冠状位和矢状位左胫骨平台阴性变化；图8　MRI图像看到骨折线和高信号骨髓水肿；图9和图10　MSCT图像冠状位和矢状位右胫骨平台骨皮质中断；图11　MRI图像没有明显的骨折线，仅在T2WI出现高信号水肿
图15 MRI、MSCT、两者联合对隐性创伤和隐性骨内骨折的诊断效能
1
Loos M, Ahmed T, Bakx R, et al. Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital [J]. Pediatr Surg Int, 2020, 36(9): 1009-1017.
2
Keyloun JW, Travis TE, Johnson LS, et al. An unusual presentation of inhalation injury in a patient with high voltage electrical injury:A case report [J]. Int J Surg Case Rep, 2020, 77(1): 357-361.
3
Liao G, Luo S, Xiao L. Borehole Nuclear Magnetic Resonance Study at the China University of Petroleum [J]. J Magn Reson, 2021, 324(4762): 106914-107014.
4
Li B, Tan MJ, Zhang HT. Interpretation method of nuclear magnetic resonance dual-TW logging in oil-wet tight sandstone reservoirs [J]. Applied Geophysics, 2020, 17(5): 796-808.
5
Kozlowski AM, Yates EA, Roubroeks JP, et al. Hydrolytic degradation of heparin in acidic environments: nuclear magnetic resonance reveals details of selective desulfation [J]. ACS Appl Mater Interfaces, 2021, 13(4): 5551-5563.
6
Caldwell R, Blankstein M, Bartlett CS, et al. MRI-only occult geriatric hip fractures: is displacement common with nonoperative treatment? [J]. Arch Orthop Trauma Surg, 2021, 141(7): 1109-1114.
7
Lunde LK, Merkus S, Koch M, et al. Associations of objectively measured total duration and maximum bout length of standing at work with lower-extremity pain intensity: a 2-year follow-up of construction and healthcare workers [J]. BMC Musculoskelet Disord, 2021, 22(1): 43.
8
Lee YH, Lee KW, Jeon GW, et al. Electron paramagnetic resonance and 1H nuclear magnetic resonance study of Y-doping effect on the Hydrogen shallow donors in ZnO nanoparticles [J]. Current Applied Physics, 2019, 19(9): 1015-1018.
9
Zhou S. The X-ray Diagnosis and Signs Analysis of Occult Elbow Fractures in Children [J]. Int J Sci, 2020, 9(6): 19-20.
10
Suwannaphisit S, Suwanno P, Tangtrakulwanich B. One-Year Follow-Up of isolated trapezoid fracture from occult trauma:a case report [J]. Int J Med Sci Clin Invent, 2020, 7(7): 4865-4867.
11
Rabah S, Robles HC, Sternman D, et al. An unusual and rare presentation of dermatomyositis sine dermatitis complicated by neuromyositis [J]. Cureus, 2020, 12(8): e10000.
12
Würdemann FS, Smeeing D, Ferree S, et al. Differentiation in an inclusive trauma system: allocation of lower extremity fractures [J]. World J Emerg Surg, 2018, 13(1): 18.
13
Hjartnes TN, Srland GH, Simon S, et al. Demulsification of crude oil emulsions tracked by pulsed field gradient (PFG) nuclear magnetic resonance (NMR). part I: chemical demulsification [J]. Ind Eng Chem Res, 2019, 58(6): 2310-2323.
14
Xu H, Fan Y, Hu F, et al. Characterization of pore throat size distribution in tight sandstones with nuclear magnetic resonance and High-Pressure Mercury intrusion [J]. Energies (Basel), 2019, 12(8): 1528-1544.
15
Chen L, Xu S. Diagnostic performance of CT for occult proximal femoral fractures: more details, more significance [J]. AJR Am J Roentgenol, 2020, 214(4): W74.
16
Griffioen M, Ziegler M, Dorsey S, et al. Change in pain scores following administration of analgesics in patients with lower extremity fractures [J]. J Pain, 2018, 19(3): S75.
17
Nam S H, Han M S. Application of Nuclear Magnetic Resonance Spectroscopy for Quantitative Analysis of Fluorine in Adult Fluorine-containing Dentifrice [J]. J Magn, 2019, 24(4): 776-780.
18
Ycp A, Ksu B, Sph B, et al. Preoperative"computed tomography capsular sign"for the detection of occult ipsilateral femoral neck fractures associated with femoral shaft fractures-ScienceDirect [J]. Injury, 2020, 51(4):1051-1056.
19
Gordon CP, Ltsch L, Copéret C. Nuclear Magnetic Resonance: A Spectroscopic Probe to Understand the Electronic Structure and Reactivity of Molecules and Materials [J]. J Phys Chem Lett, 2021, 12(8): 2072-2085.
20
Ackermann O, Simanowski J, Eckert K. Fracture Ultrasound of the Extremities [J]. Ultraschall Med, 2020, 41(1): 12-28.
21
Li D, Wang H, Ren Y, et al. Electromagnetic Design and Mechanical Behavior Analysis of an 850MHz All REBCO Nuclear Magnetic Resonance Magnet [J]. IEEE Trans Appl Supercond, 2021, 31(3):1-9.
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