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多层螺旋CT后处理技术对儿童肱骨髁上骨折的诊断价值分析*

作者:张少峰1 罗一博2

所属单位:1.陕西省宝鸡市人民医院骨一科 2.陕西省宝鸡市人民医院影像科(陕西 宝鸡 721000)

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摘要

目的探讨多层螺旋CT后处理 技术对儿童肱骨髁上骨折的诊断价值。 方法 选取我院2017年4月-2017年7月收 治的62例肱骨髁上骨折患者,62例患 者均进行了CT平扫及图像后处理,分析 肱骨髁上骨折的CT平扫、CT后处理图像 特点,比较CT平扫、后处理技术对肱 骨髁上骨折诊断的检出率、灵敏度及特 异度。结果 CT后处理技术对肱骨髁上 骨折的检出率、灵敏度及特异度分别为 100%、98.38%、98.38%,明显高于CT平 扫90.32%、85.48%、87.09%,差异具有 统计学意义(χ2 =6.305、6.961、5.871, P<0.05);54例患者可见其肱骨髁上出现 骨质连续性中断,断端对位对线欠佳, 36例患者周围见游离小骨块影;MIP图像 可直观显示骨折线及断端移位情况,VR 图像可多角度明确显示断端的旋转移位 情况,39例(62.90%)患者骨折远端旋转 约30°,23例(37.09%)患者骨折远端旋转 10°-15°。结论 多层螺旋CT后处理技术 对儿童肱骨髁上骨折检出率、灵敏度及 特异度高,可直观显示肱骨髁上骨折具 体情况。

Objective To explore the diagnostic value of multi-slice spiral CT (MSCT) in children with supracondylar fractures. Methods A total of 62 patients with supracondylar humerus fractures admitted and treated in our hospital from April 2017 to July 2017 were selected. All the 62 patients underwent image post-processing after CT scan, and the characteristics of CT scan and CT post-processing for supracondylar humerus fractures were analyzed, and the detection rate, sensitivity and specificity of CT scanning and CT post-processing were compared. Results The detection rate, sensitivity and specificity of CT post-treatment for supracondylar humerus fractures were 100%, 98.38% and 98.38%, respectively, significantly higher than 90.32%, 85.48%, and 87.09% of CT plain scan, with statistically significant difference (χ2 =6.305, 6.961, 5.871, P<0.05).In 54 patients, bone continuity was interrupted on the humeral condyle, with poor alignment of broken ends, and free small bone mass was observed around 36 patients. MIP images in the image visual display the line and the end of fracture shift condition, VR images can clearly show the rotating shift from multiple perspectives, 39 cases (62.90%) patients with fracture distal rotating about 30°, 23 cases (37.09%) patients with distal fracture 10°-15° rotation. Conclusion The multi-slice spiral CT post processing technique has high detection rate, sensitivity and specificity for the diagnosis of supracondylar humerus fractures in children.

【关键词】多层螺旋CT;后处理技术; 儿童肱骨髁上骨折

【中图分类号】R68

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.12.043

前言

肱骨髁上骨折是一种肘关节外骨折,极少见于成人,多见于学龄 前儿童,男性患儿多见,肱骨髁上骨折最常见的临床表现为肘内翻畸 形,DR检查为诊断肱骨髁上骨折的主要观察指标,但仅仅根据此指标 进行相关诊断,误诊、漏诊率较高,常需要采用其他的手段进行进一 步确诊[1-2]。多层螺旋CT扫描具有成像速度快、禁忌症少等优势,后 期通可对图像进行后处理,对评估骨折的损伤程度、移位距离均有准 确、直观的显示[3-4]。为此,本组研究收集了62例肱骨髁上骨折患者的 临床、影像资料,旨在探讨多层螺旋CT后处理技术对儿童肱骨髁上骨 折的诊断价值,现在报道内容如下。