腓骨远端撕脱骨折的影像学诊断：踝关节X线与CT三维重建的比较

doi:10.19723/j.issn.1671-167X.2023.01.024

摘要/Abstract

摘要：

目的: 探讨X线检查、CT三维重建(three dimensional reconstruction of computed tomography, 3D-CT)诊断腓骨远端撕脱骨折的敏感度差异，分析撕脱骨折块的影像学表现。方法: 收集2018年1—10月就诊于北京大学第三医院运动医学科行外踝韧带止点重建术的92例腓骨远端撕脱骨折的患者，根据纳入和排除标准，最终入组60例。将术中诊断作为金标准，统计术前踝关节正侧位X线检查以及3D-CT对腓骨远端撕脱骨折的诊断敏感度，并测量骨块最大径以及移位程度。在3D-CT上，用骨块中心点至腓骨前结节的距离(a)和至腓骨尖的距离(b)的比值(a/b值)来表示骨块位移程度。结果: 60例患者中，术前踝关节正侧位X线检查和3D-CT的阳性诊断例数分别为36例和52例，敏感度分别为60.0%和86.7%(P=0.004)。X线检查和3D-CT上撕脱骨块的平均直径分别为(9.2±3.9) mm和(10.5±3.2) mm。撕脱骨块中心点至腓骨前结节的平均距离(a)为(17.5±3.6) mm，至腓骨尖的平均距离(b)为(17.4±4.8) mm，a/b值平均为1.1±0.7。各项测量结果的组内相关系数(intraclass correlation efficient, ICC)范围为0.891~0.998，具有高度一致性。结论: 与X线检查相比，3D-CT诊断腓骨远端撕脱骨折具有更高的敏感度，可准确定位，便于手术方案的制定，建议对于临床上腓骨远端可疑撕脱骨折的病例应该进行3D-CT检查。

关键词: 踝关节, 撕脱性骨折, 踝外侧韧带, 成像，三维

Abstract:

Objective: 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. Methods: 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. Results: 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 (P=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. Conclusion: 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.

Key words: Ankle joint, Avulsion fracture, Lateral ankle ligament, Imaging, three-dimensional

中图分类号:

R683.42

熊士凯,史尉利,王安鸿,谢兴,郭秦炜. 腓骨远端撕脱骨折的影像学诊断：踝关节X线与CT三维重建的比较[J]. 北京大学学报（医学版）, 2023, 55(1): 156-159.

Shi-kai XIONG,Wei-li SHI,An-hong WANG,Xing XIE,Qin-wei GUO. Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT[J]. Journal of Peking University (Health Sciences), 2023, 55(1): 156-159.

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Parameter	Data
Age/years, $\bar x \pm s$	27.9±11.2
Gender, n (%)
Male	27 (45.0)
Female	33 (55.0)
Side, n (%)
Left	27 (45.0)
Right	33 (55.0)
BMI, $\bar x \pm s$	23.8±4.3
Duration time/month, $\bar x \pm s$	25.2±46.2

Parameter	Ossicle, $\bar x \pm s$	ICC value
X-ray diameter/mm, n=36	9.2±3.9	0.987
3D-CT diameter/mm, n=52	10.5±3.2	0.891
a value/mm, n=52	17.5±3.6	0.995
b value/mm, n=52	17.4±4.8	0.979
a/b value, n=52	1.1±0.7	0.998