Xiong S K, Shi W L, Wang A H, Xie X, Guo Q W
Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine, Peking University; Beijing Key Laboratory of Joint Injuries in Sports Medicine; Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Feb 18;55(1):156-159. doi: 10.19723/j.issn.1671-167X.2023.01.024.
To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.
From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.
Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.
Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.
探讨X线与计算机断层扫描三维重建（3D-CT）在诊断腓骨远端撕脱骨折时的敏感性差异，以及小骨的影像学表现。
2018年1月至10月，92例腓骨远端撕脱骨折患者到北京大学第三医院运动医学科就诊并接受手术治疗，最终根据纳入和排除标准纳入60例。术中检测作为金标准，统计术前踝关节X线和3D-CT对腓骨远端撕脱骨折的诊断敏感性。同时测量小骨的最大直径及其移位程度。在3D-CT上，用小骨中心点到腓骨前结节的距离（a）、到腓骨尖的距离（b）以及a/b值来表示小骨移位情况。
60例患者中，X线和3D-CT分别正确检测出36例和52例，敏感性分别为60.0%和86.7%（P=0.004）。X线和3D-CT上小骨的平均直径分别为（9.2±3.9）mm和（10.5±3.2）mm。小骨中心点到腓骨前结节的平均距离（a）为（17.5±3.6）mm，到腓骨尖的平均距离（b）为（17.4±4.8）mm，平均a/b值为1.1±0.7。各测量指标的组内相关系数（ICC）在0.891 - 0.998之间，一致性较高。
与X线相比，3D-CT在诊断腓骨远端撕脱骨折时具有更高的敏感性，有助于临床医生评估小骨位置并选择手术方法，临床实践中对于疑似腓骨远端撕脱骨折的患者建议行3D-CT检查。
