摘要
目的比较肋骨骨折短期内首次多层螺旋CT(MSCT)诊断及隔期联合诊断。方法回顾性分析由高、低年资甲、乙医师隔期联合诊断的47例肋骨骨折患者资料。首次MSCT常规扫描,4周后复查预扫描错位最轻的骨折,骨性骨痂明显及密度较低者以50和120 m A的低剂量扫描全肋,未见骨性骨痂者2周后120 m A扫描全肋。评估低剂量图像质量。对比骨性骨痂形成期及首次薄层图像,记录诊断结果。以Wilcoxon配对符号秩和检验2名医师2次诊断结果的差异,以Kappa统计量评价结果的一致性。结果甲、乙医师首次不完全性骨折确诊骨折总数差异均有统计学意义(Z=-3.945和-3.879,P<0.01);隔期联合诊断结果差异无统计学意义(P>0.05);除隐性骨内骨折外,2次诊断结果差异均有统计学意义(P<0.01);首次有不同处数的人为因素漏诊及疑似骨折,均有64处CT隐匿性骨折,10处不完全性骨折最终被诊断为完全性骨折,诊断率分别为73.82%(234/317)和68.14%(216/317);图像质量评估结果的一致性为很好(K=0.769、0.788、0.752和0.753)。结论隔期联合诊断可避免病理生理学、观察者因素对肋骨骨折MSCT诊断的影响,降低辐射量。
[Objective] To compare the values of first multisfice computed tomography （MSCT） diagnosis in short term and combined diagnosis at different periods in diagnosis of rib fracture. [Methods ] The clinical data of 47 patients with rib fracture were analyzed retrospectively. The clinical data were diagnosed by the senior doctor and the young one. They were checked with conventional dose at first MSCT diagnosis, and reviewed about 4 weeks after trauma. These patients with dense and low density osseous callus were rechecked with 50 mA and 120 mA dose total rib MSCT scan, respectively. No clear callus patients were rechecked with 120 mA dose MSCT scan after 2 weeks. The image quality using low dose scan was assessed. The first MSCT image and the image at osseous callus formation stage were compared for each patient, and the diagnoses by each physician were recorded. Pairing with Wilcoxon signed rank test was used to compare the differences in the two diagnoses by the two doctors. The inter-observer consistency was determined with Kappa statistics.[Results] The differences between the total of incomplete fracture and complete fraeture at first MSCT diagnosis were statistically significant （Z=-3.945, -3.879, P〈 0.01）. There were no i lifferenees in combined diagnoses all different periods （P〉 0.05）. There were differences in diagnoses by the two doctors except for occult fracture （P〈 0.01）. There were some missed diagnoses by human factors, suspecled broken in various places. For both doclors, there were 64 occult fraetures and 10 incomlllete fractures eventually diagnosed as complete fraclures. The first diagnostic rates by the senior and young doctors were 73.82%, 68.14%, respeelively. Consistency between the two medcal image quality evaluation resuhs were very good （K = 0.769, 0.788, 0.752 and 0.753）. [Conclusion] The combined diagnosis at different periods can reduce the amount of radiation and avoid the influence of pathophysiology and human factors on fracture diagnosis.
出处
《中国现代医学杂志》
CAS
北大核心
2015年第8期93-97,共5页
China Journal of Modern Medicine
