摘要
目的分析创伤性胸腰椎(TL)椎体轻微骨折的CT征象及漏诊原因.方法回顾性分析首次CT检查漏诊的63例(73个)TL椎体轻微骨折的影像资料,统计致伤原因和骨折的节段、数量及有无并发脊柱其他节段骨折,总结其CT影像征象和不同图像后处理方法的检出结果,并根据诊断标准对漏诊错误进行分类.结果本组交通伤、坠落伤、重物砸伤致TL骨折占84.1%.73个TL椎体轻微骨折中,胸腰段(T10~L2)47个,胸椎(T1~T9)11个,腰椎(L3~L5)15个,其中79.5%并发脊柱其他节段骨折.CT影像特征主要表现为终板轻度凹弧变形和椎前缘膨隆皱折或伴条带状致密骨折线,轴位和多平面重组(MPR)后处理技术检出率最佳.本组诊断错误分类为阅片满意占24.7%和易忽略的盲区占75.3%.结论创伤性TL椎体轻微骨折多为交通伤、坠落伤、重物砸伤所致脊柱多节段骨折的一部分,好发于胸腰段,熟悉其临床特点和CT影像特征,避免阅片满意的认知偏倚,应用MPR技术可有效提高早期诊断准确率.
Objective To analyze the CT signs and the reasons of missed diagnosis of traumatic thoracolumbar(TL)minor vertebral fractures.Methods Totally 63 cases(73 TL)with subtle fractures missed by CT examination for the first time were retrospectively analyzed.Counting the injuries causes,the segments and numbers of fractures,and whether other segments of the spine fracture occurred at the same rime.The clinical data such as CT imaging features and the detection results of different image post-processing methods was summarized.Results In this group,traffic injury,falling injury and heavy object injury caused TL fracture accounted fbr 84.1%(53/63).Of these cases,47 were thoracolumbar fractures(T10-L2),11 were thoracic fractures(T1-T9)and 15 were lumbar fractures(L3-L5),of which 79.5%(58/73)were complicated with other spinal fractures.The main features of CT images were mild concave arc deformation of endplate,bulging and folding of vertebral front or with banded dense fracture line.The detection rate of axial and multi-planar reconstmction(MPR)post-processing technology(73/73)was the best.The misclassification was satisfaction of search(24.7%)and inattentive bias(75.3%).Conclusion Traumatic TL vertebral body slight fracture is a part of multi segmental spinal fracture caused by traffic injury,falling injury and heavy injury.It is easy to occur in thoracolumbar segment.In order to avoid the cognitive bias of searching satisfaction,using MPR technology can effectively improve the accuracy of early diagnosis by being familiar with its clinical characteristics and CT imaging signs.
出处
《浙江临床医学》
2022年第1期110-112,共3页
Zhejiang Clinical Medical Journal
基金
浙江省台州市路桥区科技计划项目(2019A23010)。
关键词
胸腰椎
创伤
骨折
漏诊
体层摄影术
X线计算机
Thoracolumbar
Trauma
Fracture
Missed diagnosis
Tomography,X-ray computed
