螺旋CT三维重建显示X线平片在踝关节骨折中的漏诊病例分析

目的分析螺旋CT三维重建显示X线平片诊断踝关节骨折漏诊的情况,以提高踝关节骨折诊断的准确性。方法收集2010年1月～2013年2月本院80例踝关节骨折患者资料,所有患者均行踝关节X线正侧位片和螺旋CT三维重建检查,对比两种方法的诊断结果,分析X线平片漏诊原因。结果 X线平片与螺旋CT三维重建诊断相符66例（正确率为82.5%）,X线平片诊断漏诊14例（漏诊率为17.5%）,分别为后踝骨折漏诊5例、内踝骨折漏诊1例、足骨骨折漏诊3例（距骨并骰骨骨折1例、跟骨骨折1例、跖骨骨折1例）、骨折合并半脱位漏诊4例（距骨外移2例,下胫腓分离2例）、关节腔游离骨片1例。结论 X线平片对多踝骨折尤其是后踝骨折、骨折合并半脱位、足骨骨折、关节腔游离骨片容易发生漏诊,仔细观察踝关节边缘特别是胫骨后缘骨皮质及关节面是否连续、关节间隙是否增宽以及复杂损伤时及时进行螺旋CT扫描可减少漏诊发生。

The analysis of X-ray missed diagnosis in ankle fractures by spiral CT 3D reconstruction

Objective To improve the accuracy of diagnosis of ankle fractures by analyzing the cause of X-ray missed diagnosis in the ankle fractures using spiral CT 3D reconstruction. Methods The results of ankle fracture X-ray radiographs and spiral CT 3D reconstruction of 80 cases from January 2010 to February 2013 were compared, the causes of X-ray misdiagnosis were analyzed. Results X-ray in conformity with spiral CT 3D reconstruction diagnosis were found in 66 cases（82.5%）,with 14 cases missed（17.5%）.In these missed cases, there were 5 cases of posterior malleolus fractures,1 case of medial malleolus fractures, 3 cases of foot bone fracture （1 case of Talus Fractures,1 case ofcuboid and calcaneus case, 1case of metatarsal case）, 4 cases of fracture complicated with subluxation（2 case of lateral shift of the talus, 2 case of Inferior tibiofibular syndesmosis separation）,1 case of intra articular free bone fragments. Conclusion Multiple ankle fractures, especially posterior malleolus fractures, foot bone fractures, fracture complicated with subluxation and intra articular free bone fragments are easy to misdiagnosis on X-ray films. Careful observation of the edge of ankle, specifically posterior cortical bone of tibia and articular surface continuous, joint space widening and using spiral CT to scan complex injury timely can reduce the misdiagnosis of spiral CT scans.