Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
AJR Am J Roentgenol. 2010 Apr;194(4):1054-60. doi: 10.2214/AJR.09.3295.
Our purpose was to evaluate the detection of hip and pelvic fractures with radiography in the emergency department.
All MR images of the lower extremity or pelvis ordered from July 2005 through June 2008 by the emergency department after the patient had undergone radiography were retrospectively reviewed in consensus by two musculoskeletal radiologists. All radiographs and MR images were reviewed in regard to patient age and sex, MRI protocol, site of fracture, fracture identification, other possible pain generators, and unexpected findings. Receiver operating characteristics analysis was performed on the findings.
A total of 92 patients and 97 examinations were included. Our patient sample (77 women, 15 men; average age, 70.8 years; range, 19-94 years) had an elderly female bias. Sixty-five of the patients had a history of trauma. Thirteen patients (14%) with normal radiographic findings were found to have 23 fractures at MRI (six hip and 17 pelvic fractures). In 11 patients (12%) MRI showed no fracture after radiographic findings had suggested the presence of a fracture. In another 15 patients who had abnormal findings on radiographs, MRI depicted 12 additional pelvic fractures not identified on radiographs. In 43 of the 59 patients (73%) without MRI evidence of a fracture, the MRI findings suggested the presence of a potential pain generator, including muscle edema and tears, trochanteric bursitis, and hamstring tendinopathy. Receiver operating characteristics analysis for the detection of hip fractures with radiography showed an area under the curve of 0.74.
Our study showed poor sensitivity of radiography in the evaluation of hip and pelvic pain in the emergency department.
我们旨在评估放射科在急诊科对髋部和骨盆骨折的检出能力。
回顾性分析 2005 年 7 月至 2008 年 6 月间因接受放射学检查后由急诊科医生开单的所有下肢或骨盆的磁共振成像（MRI）。由两位肌肉骨骼放射科医生共同对所有的 X 线片和 MRI 进行分析，内容包括患者年龄和性别、MRI 方案、骨折部位、骨折识别、其他可能的疼痛源和意外发现。对检查结果进行接收者操作特征分析。
共纳入 92 例患者的 97 次检查。我们的患者样本（77 名女性，15 名男性；平均年龄为 70.8 岁；年龄范围 19-94 岁）具有老年女性偏倚。65 例患者有创伤史。13 例（14%）放射学检查结果正常的患者在 MRI 上发现 23 处骨折（6 处髋部骨折和 17 处骨盆骨折）。11 例（12%）患者的放射学检查结果提示骨折，但 MRI 未见骨折。在另外 15 例 X 线片上有异常发现的患者中，MRI 发现了 12 处 X 线片未识别的骨盆骨折。在 43 例（73%）无 MRI 骨折证据的患者中，MRI 结果提示存在潜在的疼痛源，包括肌肉水肿和撕裂、转子滑囊炎和腘绳肌腱病。放射学检查对髋部骨折的检出能力的接收者操作特征分析显示曲线下面积为 0.74。
我们的研究表明，放射学在急诊科评估髋部和骨盆疼痛方面的敏感性较差。
