目的 探讨多层螺旋计算机断层 扫描(MSCT)三维重建在踝关节骨折诊断中 的应用。方法 选取2017年2月-2018年2 月入院检查的疑似踝关节骨折的患者168 例进行回顾性分析。分别进行X线、MSCT 检查并进行后期三维重建[多平面重建 (MPR)、最大密度投影(MIP)、容积再现 (VR)]处理，以临床手术结果为金标准， 比较两种检查方式对踝关节骨折诊断的 灵敏度、特异度和准确度；观察X线及 MSCT三维重建技术对踝关节骨折分型(旋 后内收型、旋后外旋型、旋前外展型、 旋前外旋型、垂直压缩型)的检出情况。 结果 MSCT扫描对踝关节骨折的灵敏度 (1.000)、准确度(1.000)均明显高于X线 检查(灵敏度为0.933，准确度为0.935)， 两者特异度相同；X线对踝关节骨折漏诊 11例(旋后内收型3例、旋后外旋型2例、 旋前外展型2例、旋前外旋型2例、垂直压 缩型2例)，MSCT检查对踝关节骨折的检出 率达到100%，但误诊分型1例(将旋前外展 型判断成旋后外旋型1例)。结论 螺旋CT 对踝关节骨折的诊断结果较为可靠，且其 后期三维重建技术对踝关节骨折分型的检 出情况较好，有利于制定后期骨折手术治 疗方案。

Objective To explore the application of multi-slice spiral computed tomography (MSCT) three-dimensional reconstruction in the diagnosis of ankle fractures. Methods A total of 168 cases of patients suspected as ankle fractures admitted to the hospital from February 2017 to February 2018 were analyzed retrospectively, and they were given X-ray and MSCT examination and processed by post-three-dimensional reconstruction, including multi-planar reconstruction (MPR), maximum intensity projection (MIP) and volume rendering (VR). The results of clinical operation were used as the gold standard to compare the sensitivity, specificity and accuracy of the two methods for ankle fractures. The detection of the classification of ankle fractures (supination-adduction, supinationexternal rotation, pronation-abduction, pronation-external rotation, vertical compression type) was observed between X-ray and MSCT three-dimensional reconstruction. Results The sensitivity and accuracy of MSCT scan for ankle fractures were significantly higher than those of X-ray examination [(1.000 vs 0.933); (1.000 vs 0.935)], and the specificity of the two was the same. There were 11 cases of missed diagnosis of ankle fractures by X-ray (3 cases of supination-adduction, 2 cases of supination-external rotation, 2 cases of pronation-abduction, 2 cases of supination-external rotation, 2 cases of vertical compression), and the detection rate of ankle fractures by MSCT examination was 100%, but 1 case was misdiagnosed (taking 1 case of pronation-abduction as supination-external rotation). Conclusion Spiral CT is more reliable in the diagnosis of ankle fractures than X-ray, and the three-dimensional reconstruction has better detection of classification of ankle fractures, and it is conducive to the development of treatment regimens for late fracture surgery.