From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.).
Radiology. 2018 Feb;286(2):696-704. doi: 10.1148/radiol.2017162429. Epub 2017 Nov 2.
Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. RSNA, 2017.
目的 评估钝性外伤全身 CT 检查中肋软骨（CC）骨折的发生率，并评估 CC 骨折的分布、合并伤、损伤机制、报告的准确性以及对 30 天死亡率的影响。
材料与方法 本回顾性研究获得了机构审查委员会的批准。对 36 个月内所有因钝性外伤行全身 CT 检查的患者进行回顾性分析，并由第二位读者评估胸部外伤 CT 检查。在 1461 例行全身 CT 检查的患者中，39%（574/1461）存在胸部损伤征象（男性占 74.0%[574/574]，平均年龄 46.6 岁；女性占 26.0%[149/574]，平均年龄 48.9 岁）。计算 χ²值和 95%置信区间（CI）的比值比（OR）。采用 Cohen κ 值计算观察者间的一致性。
结果 共有 114 例患者（男性占 86.8%[114/114]，平均年龄 48.6 岁；女性占 13.2%[114/114]，平均年龄 45.1 岁）发生 221 例 CC 骨折。在所有全身 CT 检查中，CC 骨折的发生率为 7.8%（114/1461），在有胸部外伤的患者中为 19.9%（114/574）。CC 最常发生于第 7 肋骨（21.3%，47/221）。36%（41/114）的患者有双侧多发连续肋骨骨折，而其他胸部外伤患者为 14%（64/460）（OR，3.48；95%CI：2.18，5.53；P<0.0001）。与无 CC 骨折的胸部外伤患者相比，有 CC 骨折的胸部外伤患者更易发生肝损伤（13%，15/114）（OR，3.72；95%CI：1.81，7.64；P=0.0001）和主动脉损伤（4%，18/460）（OR，3.72；95%CI：1.81，7.64；P=0.0001）。检测 CC 骨折的观察者间一致性的 Kappa 值为 0.65（中等一致性）。39.5%（45/114）的初步报告中记录了 CC 骨折。有 CC 骨折的患者 30 天死亡率为 7.02%（8/114），无 CC 骨折的其他胸部外伤患者为 4.78%（22/460）（OR，1.50；95%CI：0.65，3.47；P=0.3371）。
结论 CC 骨折在高能钝性胸部外伤中较为常见，常与多发连续肋骨骨折同时发生。与无 CC 骨折的患者相比，有 CC 骨折的患者更易发生主动脉和肝损伤。RSNA，2017 年。
