Welling Rodney D, Jacobson Jon A, Jamadar David A, Chong Suzanne, Caoili Elaine M, Jebson Peter J L
Department of Radiology, University of Michigan, 1500 E Medical Center Dr., TC-2910L, Ann Arbor, MI 48109-0326, USA.
AJR Am J Roentgenol. 2008 Jan;190(1):10-6. doi: 10.2214/AJR.07.2699.
The purpose of our study was to determine which wrist fractures are not prospectively diagnosed at radiography using CT as a gold standard and to identify specific fracture patterns.
Through a search of radiology records from January 1 to December 31, 2005, 103 consecutive patients were identified as having radiographic and CT examinations of the wrist. After excluding incomplete or nondiagnostic examinations and those with a greater than 6-week interval between imaging studies, the final study group consisted of 61 wrist examinations in 60 patients. Two musculoskeletal radiologists and one emergency radiologist blindly reviewed CT examinations, and each bone (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was categorized as normal or fractured, with agreement reached by consensus. Each prospective radiographic report was categorized as either normal or fracture/equivocal for each osseous structure. Results were compared using the chi-square and Fisher's exact tests.
In the proximal carpal row, lunate and triquetrum fractures were often radiographically occult (0% and 20%, respectively, detected at radiography); whereas in the distal carpal row, trapezoid, capitate, and hamate fractures were often occult (0%, 0%, and 40% detected at radiography, respectively). Hamate fractures were significantly associated with metacarpal fractures, and distal radius fractures were associated with scaphoid and ulna fractures.
Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross-sectional imaging for diagnosis.
本研究旨在确定哪些腕部骨折在以CT作为金标准的情况下未能在X线摄影中得到前瞻性诊断，并识别特定的骨折类型。
通过检索2005年1月1日至12月31日的放射学记录，103例连续患者被确定为接受了腕部的X线摄影和CT检查。在排除不完整或无法诊断的检查以及两次影像学检查间隔超过6周的患者后，最终研究组由60例患者的61次腕部检查组成。两名肌肉骨骼放射科医生和一名急诊放射科医生对CT检查进行了盲法评估，每块骨头（舟骨、月骨、三角骨、豌豆骨、大多角骨、小多角骨、头状骨、钩骨、掌骨、桡骨远端、尺骨远端）被分类为正常或骨折，通过协商达成一致意见。每份前瞻性X线摄影报告针对每个骨结构被分类为正常或骨折/可疑。使用卡方检验和Fisher精确检验比较结果。
在近端腕骨列中，月骨和三角骨骨折在X线摄影中常为隐匿性（分别为0%和20%在X线摄影中被检测到）；而在远端腕骨列中，小多角骨、头状骨和钩骨骨折常为隐匿性（分别为0%、0%和40%在X线摄影中被检测到）。钩骨骨折与掌骨骨折显著相关，桡骨远端骨折与舟骨和尺骨骨折相关。
30%的腕部骨折在X线摄影中未得到前瞻性诊断，这表明如果临床有必要，在X线摄影结果为阴性后应考虑进行CT检查。舟骨背侧撕脱骨折的位置强调了进行特定X线摄影视图或横断面成像以进行诊断的必要性。
