Eggenberger Eileen, Hildebrand Gregory, Vang Sandy, Ly Amanda, Ward Christina
Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN USA.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN USA.
Iowa Orthop J. 2019;39(1):179-183.
Elderly patients who fall account for more than two million emergency department visits each year. In 4-10 % of these patients, initial plain radiographs do not identify a hip or pelvis fracture later diagnosed with advanced imaging. No consensus exists about what type of imaging, CT or MRI, should be obtained in elderly patients with hip or pelvic pain after a low energy trauma. The purpose of this study was to determine whether CT or MRI is more likely to result in a definitive fracture diagnosis in elderly patients with hip or pelvic pain after low energy trauma.
A retrospective chart review was conducted of all patients who presented to the ED at a single level one trauma center over a 4.5 year period. Inclusion criteria were age greater than fifty years old, presentation with hip and/ or pelvis pain due to a low energy trauma, and radiographic imaging including both plain radiographs and at least one pelvis MRI or CT.
Of the 218 patients who met inclusion criteria and had negative initial plain radiographs, CT or MRI later diagnosed a fracture in 69 patients (32%). Seventy eight patients underwent MRI (24 fractures, 32%), 132 underwent CT imaging (41 fractures, 31%), and eight had both CT and MRI (5 fractures, 63%). Patients who underwent CT spent less time in the ED on average (430 minutes) than those who underwent MRI, or MRI and CT (502 minutes and 620 minutes respectively). Patients who underwent CT were just as likely to be diagnosed with a fracture as those who underwent MRI (p= 0.002). We encountered no cases where CT imaging did not identify a fracture that was later identified on MRI. Fifty six patients (26%) had at least one contraindication to MRI.
Our study suggests CT may be adequate to rule out hip and pelvic fractures in this patient population. CT may be preferable to MRI based on decreased time spent in the ED and the large percentage of elderly patients with contraindications to MRI. III.
每年有超过200万老年患者因跌倒前往急诊科就诊。在这些患者中，4%-10%的患者最初的X线平片未发现髋部或骨盆骨折，而后续通过先进影像学检查确诊。对于低能量创伤后出现髋部或骨盆疼痛的老年患者，应采用何种影像学检查（CT或MRI）尚无共识。本研究的目的是确定CT或MRI在低能量创伤后出现髋部或骨盆疼痛的老年患者中，哪一种更有可能做出明确的骨折诊断。
对一家一级创伤中心在4.5年期间所有到急诊科就诊的患者进行回顾性病历审查。纳入标准为年龄大于50岁、因低能量创伤出现髋部和/或骨盆疼痛、并进行了包括X线平片以及至少一次骨盆MRI或CT的影像学检查。
在符合纳入标准且最初X线平片结果为阴性的218例患者中，CT或MRI后来诊断出骨折的有69例（32%）。78例患者接受了MRI检查（24例骨折，32%），132例接受了CT检查（41例骨折，31%），8例同时接受了CT和MRI检查（5例骨折，63%）。接受CT检查的患者在急诊科平均停留时间（430分钟）比接受MRI检查或同时接受MRI和CT检查的患者短（分别为502分钟和620分钟）。接受CT检查的患者与接受MRI检查的患者骨折诊断率相同（p = 0.002）。我们未遇到CT检查未发现而MRI后来发现骨折的病例。56例患者（26%）至少有一项MRI检查禁忌证。
我们的研究表明，CT可能足以排除该患者群体中的髋部和骨盆骨折。基于在急诊科停留时间缩短以及有MRI检查禁忌证的老年患者比例较高，CT可能比MRI更可取。III.
