目的探讨三维CT重建及MRI 检查在胫骨平台隐性骨折(TPOF)诊疗 中的应用价值。方法 收集2016年11月 至2018年11月我院收治的125例疑诊为 TPOF患者的临床资料，分析所有患者三 维CT重建及MRI影像资料，比较两种影 像学方法诊断TPOF的敏感度、特异度、 准确度。结果 共125例疑诊TPOF患者 中，最终临床诊断TPOF共104例，无骨 折21例；以最终诊断临床诊断为金标 准，MRI诊断TPOF的敏感度、准确度分 别为98.08%、98.40%，均明显高于三维 CT重建的75.00%、79.20%(P<0.05)，而 两者特异度均为100.00%。对于累及骨 皮质的TPOF，三维CT重建的敏感度、特 异度、准确度分别为100.00%(73/73)、 100.00%(29/29)、100.00%(102/102)， 均优于MRI的80.82%(59/73)、 67.44(29/43)、86.27%(88/102)。三维 CT重建与MRI在骨折部位、关节面塌陷、 骨折错位的显示满意度评分比较上差异 无统计学意义(P>0.05)，而MRI在周围软 性组织(半月板、韧带等)显示满意度评 分明显高于CT(P<0.05)。结论 对于X线 检查后疑诊TPOF，MRI可作为进一步明确 诊断的首选方法，而联合三维重建CT有 助于提高诊断准确度。

Objective To explore the application value of three-dimensional CT reconstruction and MRI in the diagnosis and treatment of tibial plateau occult fracture (TPOF). Methods The clinical data of 125 patients with suspected TPOF admitted to our hospital from November 2016 to November 2018 were collected. Three-dimensional CT reconstruction and MRI images of all patients were analyzed. The sensitivity, specificity and accuracy were compared between the two imaging methods for the diagnosis of TPOF. Results Of the total 125 patients with suspected TPOF, 104 cases were finally diagnosed as TPOF and 21 cases without fracture. The final clinical diagnosis was golden standard. The sensitivity and accuracy of MRI in diagnosis of TPOF (98.08% and 98.40%) were higher than those of three-dimensional CT reconstruction (75.00% and 79.20%) (P<0.05). The specificity of both was 100.00%. For the diagnosis of TPOF involving the cortex of bone, the sensitivity, specificity and accuracy of three-dimensional CT reconstruction [100.00% (73/73), 100.00% (29/29) and 100.00% (102/102)] were superior to those of MRI [80.82% (59/73), 67.44 (29/43), 86.27% (88/102)]. There was no statistically significant difference between three-dimensional CT reconstruction and MRI in satisfaction scores of displaying the site, articular surface collapse and dislocation of fractures (P>0.05). However, the satisfaction scores of MRI in showing surrounding soft tissues (meniscus, ligaments, etc.) were significantly higher than those of CT (P<0.05). Conclusion For patients with suspected TPOF after X-ray examination, MRI can be used as the preferred method for further diagnosis, and the combined use of three-dimensional CT reconstruction can help improve the diagnostic accuracy.