摘要
目的探讨Lisfranc关节损伤的64层螺旋CT表现及其诊断价值。方法应用64层螺旋CT对47例临床疑是Lisfranc关节损伤的病例进行各向同性的容积扫描并进行各种后处理重建,判断是否为Lisfranc关节损伤,并就Lisfranc关节损伤、Lisfranc关节中各柱损伤、Lisfranc关节中各种骨折及脱位的检出情况与X线平片进行对比。结果 47例中,41例为Lisfranc关节损伤,按Myerson标准分型:单纯内侧柱损伤4例,单纯中间柱损伤6例,单纯外侧柱损伤3例,内侧柱伴中间柱损伤11例,中间柱伴外侧柱损伤8例,三柱均损伤9例。41例Lisfranc关节损伤及6例非Lisfranc关节损伤64层螺旋CT均明确诊断,X线平片确诊或疑是Lisfranc关节损伤33例,漏诊8例。6例非Lisfranc关节损伤X线平片4例误诊为或疑是为Lisfranc关节损伤。X线平片诊断Lisfranc关节损伤的敏感性、特异性、准确性分别为80.5%、33.3%、74.5%,64层螺旋CT诊断Lisfranc损伤的敏感性、特异性、准确性分别为100%、100%、100%。41例Lisfranc关节损伤患者中24处内侧柱损伤、34处中间柱损伤、20处外侧柱损伤共103处骨折及80处关节脱位64层螺旋CT均明确显示,X线平片分别漏诊9处中间柱损伤、3处内侧柱损伤、3处外侧柱损伤,共漏诊37处骨折、26处脱位。64层螺旋CT、X线平片对Lisfranc关节损伤检出率比较,二者差异具有统计学意义(x2=8.86,P=0);64层螺旋CT、X线平片对Lisfranc关节中间柱损伤检出率比较,二者差异具有统计学意义(x2=10.37,P=0),对于内侧柱、外侧柱损伤检出情况比较,二者差异无统计学意义(x2=3.2、3.24,P=0.07、0.07);64层螺旋CT、X线平片对Lisfranc关节损伤中骨折、脱位检出率比较,二者差异具有统计学意义(x2=45.1、31.04,P=0、0)。结论 Lisfranc关节损伤以多柱受损常见,其中以内侧柱和中间柱联合损伤最多见,其次为三柱同时受累,在三柱结构中中间柱最易受损。64层螺旋CT可以清晰显示Lisfranc关节损伤并准确判断损伤类型,对Lisfranc关节损伤导致的各柱损伤、各种骨折及脱位能明确诊断,可作为X线平片的有效补充,具有较高的临床应用价值。
Objective To evaluate 64-row helical CT findings and diagnostic value of Lisfranc injury. Methods Volume data of isotropic scanning for 47 patients suspected with Lisfranc injury were performed using 64 row helical CT, the MPR, MIP and VR images were reconstructed, and the results were compared with the findings obtained from plain X-ray films. Results There were 41 cases of Lisfranc injuries among 47 patients,including 4 cases of single medial column inju- ry, 6 cases of middle column injuries, 3 cases of single lateral column injury, 11 cases with medial and middle column inju- ries, 8 cases with middle and lateral column injuries, and 9 cases with three column injuries by Myerson^s classification. Forty-one cases of Lisfranc injuries and 6 cases of other injuries were all diagnosed correctly by 64-row helical CT. Thirty- three cases of Lisfranc injuries were correctly diagnosed or suspected by plain X-ray films and 8 cases were mis diagnosed. Four IAsfranc injuries diagnosed by plain X-ray films were proved to be false positive on 64-row helical CT. The sensitivi- ty,specificity and accuracy of X-ray film diagnosis for I.isfranc injury were 80.5~//00, 33.3~ and 74.5~ respectively. The sensitivity, specificity and accuracy of 64-row helical CT diagnosis for Lisfranc injury were 100~/00, 100~ and 100G re spectively. Twenty four cases of medial column injuries, 34 cases of middle column injuries, 20 cases of lateral column in juries, 103 fractures, and 80 dislocations were diagnosed correctly by 64-row helical CT in 41 cases of Lisfranc injuries,whereas, 9 cases of middle column injuries, 3 cases of medial column injuries, 3 cases of lateral column injuries, 37 frae tures and 26 disloca tions were missed by X-ray films. There were significent differeces in detection rate of Lisfranc injury, middle column injuries, fractures and dislocations between 64 row helical CT and X ray film （X2 =8. 86, P 0; X2= 10.37, P 0;X2 =-45.1, P =0; X2 =31.04, P =0）. There were no significant differences in detection rate of medial col umn injuries and lateral column injuries between 64 row helical CT and X ray film （X2 =3.2, P 0.07; X2=3.24, P 0.07）. Conclusion The middle column combined with medial column injury is the most common injury in Lisfranc injury, followed by tri column injury. The medial column is most easily injured in Lisfrane joint. 64 row helical CT reconstruction images can show Lisfrane injuy clearly, and accurately classifies for it, which can also reveal fractures and dislocations in I.isfranc injury. 64-row helical CT is recommended as a complementary examination in patients suspected with Lisfranc in- jury, which has great clinical value.
出处
《医学影像学杂志》
2013年第2期285-290,共6页
Journal of Medical Imaging
