CT 扫描中空气对于 1 型开放性骨折评估的效用。

The utility of air on computed tomography scans in the assessment of type 1 open fractures.

机构信息

Department of Orthopaedics, Naval Medical Center San Diego, San Diego, CA, USA.

Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CL, 80204, USA.

出版信息

Eur J Orthop Surg Traumatol. 2023 May;33(4):1263-1266. doi: 10.1007/s00590-022-03296-x. Epub 2022 May 23.

DOI:10.1007/s00590-022-03296-x

PMID:35604477

Abstract

PURPOSE

The presence of air on computed tomography (CT) scans has been demonstrated to accurately diagnose occult traumatic arthrotomies. The purpose of this study was to determine if the presence of air on CT scans also has diagnostic utility for type 1 open fractures.

METHODS

A retrospective review at a level 1 trauma center identified twenty-eight patients with Gustilo-Anderson Type 1 open fractures and preoperative CT scans. These patients were matched 2:1 with 56 closed fractures who also had CT scans. CT scans were reviewed to determine the presence of suprafascial and subfascial air.

RESULTS

Air near the fracture site on CT scan was more common in open fractures then closed fractures (21 (75%) vs. 9 (16%) patients, proportional difference: 59% (37-75%), p < 0.0001). In the open fracture group, 18 (64.2%) patients had both supra- and subfascial air, 2 (7.1%) patients had isolated subfascial air, and 1 (3.5%) patient had isolated suprafascial air. In the closed fracture group, 3 (5.3%) patients had supra- and subfascial air, 4 (7.1%) had isolated subfascial air, and 2 (3.5%) had isolated suprafascial air. The sensitivity and specificity of air on CT for identifying a type 1 open fracture was 75 and 84%, respectively.

CONCLUSIONS

This study found that the presence of air on CT scan was more likely in type 1 open versus closed fractures; however, the sensitivity or specificity was too low to be used reliably to identify occult open fractures in isolation.

LEVEL OF EVIDENCE

Diagnostic Level III.

摘要

目的

计算机断层扫描（CT）上的空气存在已被证明可准确诊断隐匿性创伤性关节切开术。本研究的目的是确定 CT 扫描上的空气是否也对 1 型开放性骨折具有诊断效用。

方法

在 1 级创伤中心进行回顾性研究，确定了 28 例 Gustilo-Anderson 1 型开放性骨折和术前 CT 扫描的患者。这些患者与 56 例闭合性骨折患者以 2:1 的比例配对，这些患者也进行了 CT 扫描。对 CT 扫描进行评估，以确定筋膜上和筋膜下空气的存在。

结果

CT 扫描上骨折部位附近的空气在开放性骨折中比闭合性骨折更为常见（21 例（75%）与 56 例（16%）患者，比例差异：59%（37-75%），p<0.0001）。在开放性骨折组中，18 例（64.2%）患者既有筋膜上空气也有筋膜下空气，2 例（7.1%）患者仅有筋膜下空气，1 例（3.5%）患者仅有筋膜上空气。在闭合性骨折组中，3 例（5.3%）患者既有筋膜上空气也有筋膜下空气，4 例（7.1%）患者仅有筋膜下空气，2 例（3.5%）患者仅有筋膜上空气。CT 扫描上空气识别 1 型开放性骨折的敏感性和特异性分别为 75%和 84%。