螺旋CT在外伤性腕骨脱位或骨折-脱位诊断中的价值

目的 探讨螺旋CT多平面重建在腕骨外伤性脱位、骨折并脱位中的诊断价值。 方法 回顾性分析48例经临床资料证实的腕骨脱位或腕骨骨折-脱位患者的临床、影像资料，分析X线检查、CT（包括轴位、MPR及VR重建）在腕关节脱位诊断中的价值。 结果 经临床随访确诊的48例患者中，多排螺旋CT诊断准确率为100%，X线准确率为70.83%，CT与X线在腕关节脱位的检出方面存在显著差异（χ2=4.5，P<0.05）。X线上漏诊的病例中，10例因未能发现舟骨、三角骨的细小骨折导致。本组中X线中4例误诊，其中以豌豆骨脱位误诊率较高。 结论 X线对于腕关节脱位发现率较高，但是对于腕骨细小骨折的发现能力不足，螺旋CT的MPR、VR重建能清晰显示腕骨移位、骨折等，为临床制定治疗方案提供影像学支持。此外，X线对于脱位存在误诊多与患者伤后处于被动姿态有关。  

Value of spiral CT in diagnosis of traumatic carpal dislocation or fracture-dislocation

Objective To evaluate the diagnostic value of spiral CT multiplanar reconstruction in traumatic carpaldislocation or fracture-dislocation. Methods The clinical and imaging data of 48 cases confirmed of carpal dislocation or fracture-dislocation were retrospective analyzed.The diagnostic accuracy of plain film radiography, CT (axial, MPR and VR reconstructionincluded) in the diagnosis of wrist dislocation were compared. Results In 48 patients diagnosed by clinical data, accuracy of spiral CT was 100% and accuracy of plain film radiography was 70.83%. There was significant difference of carpaldis location detection between CT and X-ray (χ2=4.5, P<0.05). Ten cases were unable to detect the small fractures of scaphoid and triquetrum in the X-ray missed cases. Four cases were misdiagnosed in plain film which pisiform was the most common. Conclusion Small carpal fractures may be missed even in a high detection rate of carpal dislocation in X-ray. MPR and VR reconstruction of spiral CT can clearly show carpal dislocation and fracture, provide imaging supports for clinical treatment. In addition, misdiagnosis of dislocation of some carpal in the plain film are caused by the passive position of patients.