高频超声与多层螺旋CT对隐匿性肋骨骨折的诊断价值分析(1)
摘要：目的 探讨高频超声与多层螺旋CT诊断隐匿性肋骨骨折的价值。方法 将50例隐匿性肋骨骨折病例按照知情自愿的原则分为两组，A组32例，B组18例分别行高频超声和MSCT检查，分析其图像资料。结果 ①A组超声诊断肋骨骨折30例(52根)，2例漏诊，诊断准确率93.75%。其中单发肋骨骨折20例，多发肋骨骨折11例，肋软骨骨折1例，骨折部位以第3~10前肋及腋缘多见，骨折断端错位0.5~6.5mm；②B组MSCT诊断肋骨骨折17例(35根)，1例漏诊，诊断准确率94.44%。其中单发肋骨骨折12例，多发肋骨骨折6例，完全性肋骨骨折21根，不完全性肋骨骨折14根，21根完全性肋骨骨折中断端错位均不超过3个皮质厚度；③两者诊断准确率基本一致，对骨折部位、数量及移位情况均能清晰显示。结论 高频超声和多层螺旋CT诊断隐匿性肋骨骨折准确率均较高。综合考虑两者优缺点，超声检查可作为诊断隐匿性肋骨骨折的主要检查方法。
关键词：隐匿性肋骨骨折；高频超声；多层螺旋CT
Analysis of High Frequency Ultrasound and Multi-slice Helical CT in Diagnosis of Occult Fracture of Rib
LI Yu-shuang, JIA Bin,XIA Bai,TIAN Zhi-ming,CHEN Zhi-lin
(Department of Radiology, Nanjing Dachang Hospital, Nanjing 210035,Jiangsu,China)
Abstract：ObjectiveTo explore the value of high frequency ultrasound andMSCT in the diagnosis of occult fracture of rib. Methods 50 cases of occult rib fracture were in accordance with the principle of voluntary were divided into two groups, 32 cases of group A and group B, 18 cases of line of high frequency ultrasound and MSCT examination respectively, analysis of the image data. Results①A set of ultrasonic diagnosis of rib fracture 30 cases (52), 2 cases of misdiagnosis, diagnosis accuracy rate 93.75%.Single fractured ribs on 20 cases, 11 cases multiple fractured ribs, costal cartilage fracture in 1 case, rib fracture with 3~10 before and axillary edge, fracture dislocation, 0.5 to 6.5 mm. ②The B group of MSCT in the diagnosis of rib fracture of 17 cases (35), 1 case of missed diagnosis, diagnostic accuracy of 94.44%.Single rib fractures in 12 cases, 6 cases of multiple fractured ribs, completeness fractured ribs 21 root, incomplete 14 root ribs fracture, 21 root complete interruption of fractured ribs end displacement are not more than three cortical thickness. ③both the accuracy rate of diagnosis is consistent, the fracture location, number and displacement can clearly display.Conclusion High frequency ultrasound and MSCT in the diagnosis of occult rib fracture were higher accuracy.Considering both the advantages and disadvantages, ultrasound can be as the main examination methods of diagnosing occult rib fracture.
Key words：Occult fracture of rib; High frequency ultrasound; Multi-slice helical CT
肋骨骨折在胸部外伤中最常见，X线平片是诊断肋骨骨折的首选影像学检查方法，但对不完全性骨折或无明显移位的骨折，X线平片不易发现，且由于受患者检查时被动体位、胸部并伤等诸多因素的影响，X线检查肋骨骨折发生漏诊的情况仍然存在[1]。 如何避免肋骨骨折的漏诊并且及时准确地发现X线平片阴性的隐匿性肋骨骨折，是当前临床工作的当务之急。随着医学影像学技术的迅猛发展，高频超声和多层螺旋CT在诊断肋骨骨折方面的研究逐渐增多[2-6]，并在临床实践中得到了验证。笔者对比分析50例隐匿性肋骨骨折的高频超声与CT的影像学资料，就其诊断价值进行探讨， 现报道如下。
1资料与方法
1.1一般资料50例因胸部外伤拍片未显示骨折，而临床上仍怀疑为肋骨骨折，建议行超声或CT检查的病例。按照知情自愿的原则分为两组。A组为超声组，共32例，男20例，女12例，年龄19~63岁，平均37.2岁。B组为CT组 ，共18例，男13例，女5例，年龄22~70岁，平均年龄38.5岁。所有病例均有明确的外伤史且受伤部位局部疼痛，压痛明显。
1.2高频超声检查方法使用GEP6、MyLab90彩超，线阵探头，频率7.5~12MHz。患者取仰卧位或侧卧位，于胸壁疼痛或肿胀部位沿肋骨长轴方向检查，观察骨皮质回声是否连续，若发现骨折，以骨折处为中心行各切面检查，与临近肋骨对照，对于可疑骨折可行探头加压扫查。以胸骨角作为第二肋的标志向下依次类推骨折部位。
1.3多层螺旋CT检查方法使用PHILIPS MX 16-slice型螺旋CT机。扫描条件：120KV，300mAs，层厚、层距3mm，重建间隔2mm。检查范围包括第1肋至第12肋，一次屏气完成扫描。将原始数据传输至工作站进行重建，对图像疑有肋骨骨折的病例，采用多平面重建(MPR)、三维容积再现(VR)多角度旋转观察以显示骨折部位。, 百拇医药(李玉双 贾斌 夏柏 等)
关键词：隐匿性肋骨骨折；高频超声；多层螺旋CT
Analysis of High Frequency Ultrasound and Multi-slice Helical CT in Diagnosis of Occult Fracture of Rib
LI Yu-shuang, JIA Bin,XIA Bai,TIAN Zhi-ming,CHEN Zhi-lin
(Department of Radiology, Nanjing Dachang Hospital, Nanjing 210035,Jiangsu,China)
Abstract：ObjectiveTo explore the value of high frequency ultrasound andMSCT in the diagnosis of occult fracture of rib. Methods 50 cases of occult rib fracture were in accordance with the principle of voluntary were divided into two groups, 32 cases of group A and group B, 18 cases of line of high frequency ultrasound and MSCT examination respectively, analysis of the image data. Results①A set of ultrasonic diagnosis of rib fracture 30 cases (52), 2 cases of misdiagnosis, diagnosis accuracy rate 93.75%.Single fractured ribs on 20 cases, 11 cases multiple fractured ribs, costal cartilage fracture in 1 case, rib fracture with 3~10 before and axillary edge, fracture dislocation, 0.5 to 6.5 mm. ②The B group of MSCT in the diagnosis of rib fracture of 17 cases (35), 1 case of missed diagnosis, diagnostic accuracy of 94.44%.Single rib fractures in 12 cases, 6 cases of multiple fractured ribs, completeness fractured ribs 21 root, incomplete 14 root ribs fracture, 21 root complete interruption of fractured ribs end displacement are not more than three cortical thickness. ③both the accuracy rate of diagnosis is consistent, the fracture location, number and displacement can clearly display.Conclusion High frequency ultrasound and MSCT in the diagnosis of occult rib fracture were higher accuracy.Considering both the advantages and disadvantages, ultrasound can be as the main examination methods of diagnosing occult rib fracture.
Key words：Occult fracture of rib; High frequency ultrasound; Multi-slice helical CT
肋骨骨折在胸部外伤中最常见，X线平片是诊断肋骨骨折的首选影像学检查方法，但对不完全性骨折或无明显移位的骨折，X线平片不易发现，且由于受患者检查时被动体位、胸部并伤等诸多因素的影响，X线检查肋骨骨折发生漏诊的情况仍然存在[1]。 如何避免肋骨骨折的漏诊并且及时准确地发现X线平片阴性的隐匿性肋骨骨折，是当前临床工作的当务之急。随着医学影像学技术的迅猛发展，高频超声和多层螺旋CT在诊断肋骨骨折方面的研究逐渐增多[2-6]，并在临床实践中得到了验证。笔者对比分析50例隐匿性肋骨骨折的高频超声与CT的影像学资料，就其诊断价值进行探讨， 现报道如下。
1资料与方法
1.1一般资料50例因胸部外伤拍片未显示骨折，而临床上仍怀疑为肋骨骨折，建议行超声或CT检查的病例。按照知情自愿的原则分为两组。A组为超声组，共32例，男20例，女12例，年龄19~63岁，平均37.2岁。B组为CT组 ，共18例，男13例，女5例，年龄22~70岁，平均年龄38.5岁。所有病例均有明确的外伤史且受伤部位局部疼痛，压痛明显。
1.2高频超声检查方法使用GEP6、MyLab90彩超，线阵探头，频率7.5~12MHz。患者取仰卧位或侧卧位，于胸壁疼痛或肿胀部位沿肋骨长轴方向检查，观察骨皮质回声是否连续，若发现骨折，以骨折处为中心行各切面检查，与临近肋骨对照，对于可疑骨折可行探头加压扫查。以胸骨角作为第二肋的标志向下依次类推骨折部位。
1.3多层螺旋CT检查方法使用PHILIPS MX 16-slice型螺旋CT机。扫描条件：120KV，300mAs，层厚、层距3mm，重建间隔2mm。检查范围包括第1肋至第12肋，一次屏气完成扫描。将原始数据传输至工作站进行重建，对图像疑有肋骨骨折的病例，采用多平面重建(MPR)、三维容积再现(VR)多角度旋转观察以显示骨折部位。, 百拇医药(李玉双 贾斌 夏柏 等)