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CT囊性征在高能量损伤致股骨干骨折并发同侧隐匿性股骨颈骨折的诊断价值研究
Diagnostic value of CT capsular sign in femoral shaft fractures compbined with ipsilateral occult femoral neck fractures caused by high-energy injuries
投稿时间:2023-01-09  
DOI:10.3969/j.issn.1672-5972.2023.05.011
中文关键词:  股骨干骨折  股骨颈骨折  创伤性关节积脂血症  诊断试验
英文关键词:Femoral shaft fracture  Femoral neck fracture  Traumatic lipohemarthrosis  Diagnostic test
基金项目:
作者单位邮编
王浩然* 中国人民解放军北部战区总医院骨科辽宁 沈阳110016 110016
王晗 中国人民解放军北部战区总医院干部病房一科辽宁 沈阳110016 110016
纪振钢 中国人民解放军北部战区总医院骨科辽宁 沈阳110016 110016
周志斌 中国人民解放军北部战区总医院骨科辽宁 沈阳110016 110016
韩天宇 中国人民解放军北部战区总医院骨科辽宁 沈阳110016 110016
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中文摘要:
      目的 评估CT囊性征是否可以作为高能量损伤致股骨干骨折合并同侧隐匿性股骨颈骨折的新的诊断方法,以提高骨折的诊断准确率。方法 收集2014年1月至2020年6月就诊于中国人民解放军北部战区总医院的高能量损伤致股骨干骨折的患者的病例资料及影像学资料,并进行CT囊性征的评估。当前关节囊扩张的差值>1 mm时认为CT囊性征阳性。将病例根据是否出现股骨颈骨折及是否观察到囊性征阳性进行分组,并计算此诊断方法的灵敏度、特异度、阳性预测值、阴性预测值和约登指数。结果 本研究纳入169例患者,16例患者术前诊断为移位的同侧股骨颈骨折,而其余153例患者在伤后影像资料上未见明显同侧股骨颈骨折。在CT软组织窗图像上,153例患者中有21例(13.7%)表现为囊性征阳性。在21例囊性征阳性的患者中发现了3例合并隐匿性同侧股骨颈骨折。结论 临床医生应提高对高能量损伤致股骨干骨折的认识,进行系统查体及全面摄片以提高诊断准确率。可以将髋关节CT囊性征作为一种新的预防漏诊同侧隐匿性股骨颈骨折的诊断方法。
英文摘要:
      Objective To evaluate whether CT capsular signs can be used as a new diagnostic method for femoral shaft fractures combined with ipsilateral occult femoral neck fractures caused by high-energy injuries to improve the diagnostic accuracy.Methods Case data and imaging data of patients with femoral shaft fracture caused by high-energy injury admitted to the General Hospital of Northern Theater Command from January 2014 to June 2020 were retrospectively collected, and CT capsular signs were evaluated. CT capsular signs were considered positive when the difference between the joint capsule expansion was greater than 1 mm. The cases were grouped according to whether there was a femoral neck fracture and whether a positive capsular sign was observed, and the sensitivity, specificity, positive predictive value, negative predictive value and Youden index of this diagnostic method were calculated.Results A total of 169 patients were collected in this study, 16 patients were diagnosed with displaced ipsilateral femoral neck fractures preoperatively, while the remaining 153 patients had no apparent ipsilateral femoral neck fractures on the post-injury imaging data. On the CT soft tissue window image, 21 of the 153 patients (13.7%) showed positive capsular signs. Three cases of occult ipsilateral femoral neck fractures in 21 patients with positive capsular signs were found.Conclusion Clinicians should improve their understanding of femoral shaft fractures caused by high-energy injuries, and conduct systematic physical examinations and comprehensive radiographs to increase the diagnostic accuracy. We can use CT capsular sign of the hip as a new diagnostic method to prevent the missed diagnosis of occult femoral neck fracture.
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