多层螺旋CT足踝部隐匿性骨折的诊断价值

目的：通过对隐匿性骨折的诊断,提示足踝部外伤后X线检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查的必要性,以期减少漏诊、误诊。方法：收集2007年1月至2010年6月31例足踝部外伤病例,男18例,女13例;年龄21～67岁,平均35岁。均有明确外伤史,主要表现为足踝部疼痛,局部肿胀,压痛点固定,压痛明显,活动受限。31例X线检查均阴性,因临床高度怀疑骨折而行多层螺旋CT检查。结果：螺旋CT检查发现11例骨折,共累及17处。单发骨折6例,多发骨折5例。单发骨折中,外踝骨折1例,距骨骨折1例,足舟骨骨折1例,第5跖骨基底部骨折1例,跟骨骨折2例;多发骨折中,内、外踝骨折1例,内踝、跟骨、距骨骨折1例,距骨、足舟骨骨折1例,足第1、2楔骨骨折1例,第2、3跖骨基底部骨折1例。结论：足踝部外伤后X线片检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查,可明显提高隐匿性骨折的检出率,为临床治疗及司法鉴定提供可靠的影像学依据,具有重要的应用价值。

Value of spiral CT examination for diagnosis of occult fracture of ankle and foot

Objective: To investigate the value of spiral CT examination for diagnosis occult fracture of the patients with negative result of X-ray examination and with high suspicion of fractures,so as to reduce misdiagnosis. Methods: From January 2007 to June 2010,31 patients with ankle trauma performed spiral CT examination,including 18 males and 13 females,ranging in age from 21 to 67 years,with a mean of 35 years. The main symptoms of the patients included ankle pain,local swelling,obvious tenderness and activity limitation. All the patients had negative results of X-ray examination. Results: The spiral CT examination revealed 11 patients with fractures,involving a total of 17 points. Single fracture were found in 6 cases,and multiple fractures were found in 5 cases. Among single fractures,the lateral malleolus fracture was found in 1 case,talus fracture was found in 1 case,scaphoid fracture was found in 1 case,the fracture of the base of 5th metatarsal base was found in 1 case and calcaneal fractures were found in 2 cases. Within multiple fractures,internal and lateral malleolus fracture were found in 1 case;medial malleolus,calcaneus and talus fractures were found in 1 case; talus and scaphoid fractures were found in 1 case;the fractures of 1st and 2nd cuneiform bone were found in 1 case;the 2nd and 3rd metatarsal base fracture was found in 1 case. Conclusion: For the patients with negative X-ray examination and high suspicion of fractures,the spiral CT examination is needed,which could significantly improve the detection rate of occult fractures,and provide imaging basis for clinical treatment and judicial identify.