Anderson I F, Crichton K J, Grattan-Smith T, Cooper R A, Brazier D
Department of Diagnostic Radiology, Royal North Shore Hospital of Sydney, St. Leonards, Australia.
J Bone Joint Surg Am. 1989 Sep;71(8):1143-52.
Twenty-four patients who had an osteochondral fracture of the dome of the talus were examined by plain radiography, magnetic resonance imaging, computerized tomography, and, when indicated, scintigraphy. When plain radiographs of the ankle are relied on for the diagnosis of an osteochondral fracture of the talus, many lesions remain undiagnosed. Stage-I osteochondral fractures show no diagnostic changes on plain radiographs, and Stage-II lesions are usually subtle and, therefore, are often overlooked by both radiologists and clinicians. The use of scintigraphy as a screening procedure and of magnetic resonance imaging for patients who have positive scintiscans showed that osteochondral fractures are more common than has previously been indicated in the literature. Scintigraphy should be used to assess patients when there is clinical suspicion of an osteochondral fracture but the plain radiographs appear to be negative. Patients who have positive scintiscans should be assessed by magnetic resonance imaging. Patients who have abnormal plain radiographs will derive no major benefits from magnetic resonance imaging; for all but one of these patients, computerized tomography was adequate for staging the fracture.
对24例距骨穹窿部骨软骨骨折患者进行了X线平片、磁共振成像、计算机断层扫描检查，必要时还进行了骨闪烁显像检查。若仅依靠踝关节X线平片诊断距骨骨软骨骨折，许多损伤会漏诊。Ⅰ期骨软骨骨折在X线平片上无诊断性改变，Ⅱ期损伤通常较隐匿，因此常被放射科医生和临床医生忽视。将骨闪烁显像作为筛查手段，并对骨闪烁显像阳性的患者进行磁共振成像检查，结果显示骨软骨骨折比以往文献报道的更为常见。当临床怀疑存在骨软骨骨折但X线平片表现为阴性时，应采用骨闪烁显像对患者进行评估。骨闪烁显像阳性的患者应接受磁共振成像检查。X线平片异常的患者从磁共振成像检查中不会获得太大益处；除其中1例患者外，对所有这些患者而言，计算机断层扫描足以对骨折进行分期。
