目的 对比分析多层螺旋CT(MSCT)与MRI对早期隐匿性骨折的临床诊断效果。方法 回顾性分析联勤保障部队第940医院2020-01-01至2024-12-31收治的120例下肢隐匿性骨折患者的临床资料,其中男75例,女45例,年龄15~55岁,受伤时间3~72 h,所有患者均同时行CT及MRI检查。通过双盲法评估,比较3.0T MRI和MSCT对下肢隐匿性骨折部位的诊断准确性效能,分析下肢隐匿性骨折的MRI和MSCT影像学表现。结果 MRI诊断下肢隐匿性骨折的检出率为95.0%,高于MSCT的88.33%,尤其在长骨骨折中表现更为突出。MRI对胫骨隐匿性骨折的诊断准确率为100%,其次是跖、趾骨(95.45%)、腓骨(94.74%)及股骨(92.86%)。结论 MRI在早期精准诊断隐匿性骨折方面准确性较高,且对详细揭示骨折周围的骨髓水肿范围和程度,明显优于MSCT。可为临床精准诊断及个性化治疗方案的选择提供较大帮助。
Abstract
Objective To compare and analyze the clinical diagnostic efficacy of multi-slice spiral computed tomography(MSCT) and MRI for early occult fractures. Methods A retrospective analysis was conducted on the clinical data of 120 patients with lower limb occult fractures admitted to the 940th Hospital of PLA Joint Logistics Support Force from January 1, 2020 to December 31, 2024. Among them, 75 were males and 45 were females, with ages ranging from 15 to 55 years old, and the injury time was 3 to 72 hours. All patients underwent both CT and MRI examinations simultaneously. Through a double-blind method, the diagnostic accuracy of 3.0T MRI and MSCT for the location of lower limb occult fractures was evaluated, and the imaging manifestations of MRI and MSCT for lower limb occult fractures were analyzed. Results The detection rate of MRI for lower limb occult fractures was 95%, which was higher than that of MSCT(88.33%), especially more prominent in long bone fractures. The diagnostic accuracy rate of MRI for tibial occult fractures was 100%, followed by metatarsal/phalangeal(95.45%), fibular(94.74%), and femoral fractures(92.86%). Conclusions MRI demonstrates higher accuracy in the early precise diagnosis of occult fractures, and is significantly superior to MSCT in clearly revealing the range and degree of bone marrow edema around the fractures, which can provide great assistance for clinical precise diagnosis and the selection of personalized treatment plans.
关键词
体层摄影术 /
X线计算机 /
磁共振成像 /
隐匿性骨折 /
影像学诊断
Key words
tomography /
x-ray computed /
magnetic resonance imaging /
occult fracture /
imaging diagnosis
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参考文献
[1] 蒋 英,梁晓雨,郑彦强.磁共振成像对隐匿性骨折的诊断价值分析[J].影像研究与医学应用,2018,2(24):166-167.
[2] Dean B J, Riley N, Little C, et al. The rate of nonunion in the MRI-detected occult scaphoid fracture[J].Bone Joint J,2024,106(B4):387-393.
[3] 胥少汀,葛宝丰,卢世璧.实用骨科学[M].4版.郑州:河南科学技术出版社,2019:225-227.
[4] 尹明明,刘 铭.CT联合MRI检查在腕关节损伤中的临床应用价值探讨[J].中国CT和MRI杂志,2022,20(1):183-185.
[5] Rojas C,Munjin A,Delgado G,et al. Diagnostic accuracy of MRI for detection of occult instability of type I anterior to posterior pelvic injuries[J]. Injury,2023,54 (6):110806.
[6] 刘学财.高场强3.0T MRI与多排螺旋CT对膝关节隐匿性骨折的诊断效能研究[J].影像研究与医学应用,2023,7(17):166-168.
[7] 陈钦力,范剑荣,陈学飞.多层螺旋CT三维重建和磁共振成像检查对踝关节处隐匿性骨折诊断及术后疗效的评估价值[J].黑龙江医药,2025,38(6):1434-1437.
[8] 李 彬.多层螺旋CT三维重建与磁共振成像在诊断膝关节隐匿性骨折中临床价值对比[J].中国医疗器械信息,2023,29(15):48-50.
[9] 叶清岚,李 晶,候金丹,等. 多层螺旋 CT 与 MRI 在膝关节 隐匿性骨折伴半月板及韧带损伤中的诊断比较[J]. 中国骨伤,2022,35(10):967-970.
[10] 刘伟娟,马洪舟. 踝关节损伤首选影像检查技术的调查分析[J]. 中国骨与关节损伤杂志,2024,39(6):664-666.
[11] Haims A H,Wang A,Yoo B J,et al. Negative predictive value of CT for occult fractures of the hip and pelvis with imaging follow-up[J]. Emerg Radiol,2021,28(2):259-264.
[12] 李仕骞,黄占有,拓学博. MSCT 及 MRI 技术对踝关节隐匿性骨 折的诊断价值分析[J]. 影像研究与医学应用,2023,7(11):158-160.
[13] 李 颖,刘云飞,李艳茹,等. 膝关节隐匿性骨折诊断中高场强 MRI与 MSCT 应用价值比较[J]. 中国 CT 和 MRI 杂志,2022,20(4): 177-179.
[14] 王 静,盛良驹.MRI对膝关节隐匿性骨折合并半月板及韧带损伤的诊断效能分析[J].影像研究与医学应用,2026,10(3):157-159.
[15] 陶思琦,宾俊杰.急性外伤性隐匿性骨折的影像学诊断进展[J].中国骨与关节损伤杂志,2026,41(1):55-60.
[16] 梁玉如,曹 健,孟 城.MRI及多层螺旋CT扫描后处理技术在胫骨平台骨折中的诊断价值比较[J].中国典型病例大全,2025,19(3):276-279.
[17] 汪小兰.多层螺旋CT和高场强MRI诊断膝关节隐匿性骨折的效果[J].医学信息,2026,39(1):135-138.
[18] Ruggiero S, Bellini D, Rengo M, et al. Occult femoral fracture: Be aware of dual energy computed tomography[J]. J Clin Ultrasound,2024,52(8):1254-1258.
[19] 谢 瑛,苏平昌,岳孟超. 高场强 MRI 与多层螺旋 CT 诊断膝关节隐匿性骨折灵敏度、特异度比较[J]. 中国 CT 和 MRI 杂志,2021,19(7):155-157.
[20] 陈雅倩,张卫国,何 博. MRI在膝关节隐匿性骨折诊断中的应用[J].中国CT和MRI杂志,2021,19(5):154-156.
[21] Walsh PJ, Farooq M, Walz DM. Occult fracture propagation in patients with isolated greater trochanteric fractures: patterns and management[J].Skeletal Radiol,2022,51(7):1391-1398.
[22] Guo J, Xu L, Zhang H. Clinical analysis of magnetic nanoparticle contrast agent in the diagnosis of occult fracture by multislice spiral CT and MRI[J].J Nanosci Nanotechnol, 2020,20(10):6568-6576.
[23] 马万山.多层螺旋CT与核磁共振成像在膝关节隐匿性骨折中的诊断价值对比[J].中国伤残医学,2024,32(9):33-36.
[24] 侯雪玲,懂吉哲,李 楠. 膝关节隐匿性骨折采取核磁共振成像与多层螺旋CT检查效果及价值分析[J]. 世界复合医学,2023,9(2):60-63.
[25] 陈文欢,祁子兰,朱晓娟,等.磁共振成像与多层螺旋CT在诊断膝关节隐匿性骨折中的应用价值[J].影像研究与医学应用,2025,9(15):137-139.
[26] 陈 帅,王丹丹,张联合.军事训练伤所致前交叉韧带撕裂情况分析[J].武警医学,2023,34(9):763-765.
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