CAJ | 학술논문

目的：探讨CR与CT对尺骨冠突骨折诊断价值及Negan‐Morrey分型法的应用价值。方法回顾性分析55例含尺骨冠突骨折的肘关节CR及CT图像，以临床诊断为金标准作为比对，分析CR与CT对肘关节任何部位骨折诊断准确率、肘关节骨折检出率、尺骨冠突骨折检出率及“Negan‐Morrey分型法”诊断灵敏度。结果55例肘关节骨折首诊C R准确诊断骨折33例，诊断不符22例，C R诊断准确率60％；C T 准确诊断54例，诊断不符1例，诊断准确率98．2％， CT对肘关节骨折诊断准确率优于MRCR（礸2＝24．24，P ＜0．05）。以“肘关节骨折中至少检出一处”为标准，CR检出41例，漏诊14例，检出率为74．55％，C T全部检出（100％）。M RC T对肘关节骨折检出率优于C R （礸2＝16．04， P ＜0．05）。仅对尺骨冠突骨折分析，C R检出37例，阴性18例，检出率67．27％，M RC T 全部检出（100％）。M RC T 对尺骨冠突骨折检出率优于C R （礸2＝21．52， P ＜0．05）。尺骨冠突骨折C R分型：I型19例，Ⅱ型12例，Ⅲ型6例，未分型18例；M RC T分型：I型26例，Ⅱ型14例，Ⅲ型14例，未分型1例。与临床分型比较，4例M RC T诊断为II型，而临床诊断为Ⅲ型，2例MRCT诊断为Ⅱ型，临床诊断为I型。尺骨冠突骨折MRCT分型敏感性高于CR（ P ＜0．05）。结论 CR对肘关节骨折具有较高的检出率，但诊断准确性不高，对尺骨冠突骨折检出率及骨折分型敏感性低于MRCT ；对CR诊断肘关节骨折尤其怀疑尺骨冠突骨折病例应行M RC T检查，对减少漏诊及指导临床制定合理的治疗方法意义重大。
목적：탐토CR여CT대척골관돌골절진단개치급Negan‐Morrey분형법적응용개치。방법회고성분석55례함척골관돌골절적주관절CR급CT도상，이림상진단위금표준작위비대，분석CR여CT대주관절임하부위골절진단준학솔、주관절골절검출솔、척골관돌골절검출솔급“Negan‐Morrey분형법”진단령민도。결과55례주관절골절수진C R준학진단골절33례，진단불부22례，C R진단준학솔60％；C T 준학진단54례，진단불부1례，진단준학솔98．2％， CT대주관절골절진단준학솔우우MRCR（찰2＝24．24，P ＜0．05）。이“주관절골절중지소검출일처”위표준，CR검출41례，루진14례，검출솔위74．55％，C T전부검출（100％）。M RC T대주관절골절검출솔우우C R （찰2＝16．04， P ＜0．05）。부대척골관돌골절분석，C R검출37례，음성18례，검출솔67．27％，M RC T 전부검출（100％）。M RC T 대척골관돌골절검출솔우우C R （찰2＝21．52， P ＜0．05）。척골관돌골절C R분형：I형19례，Ⅱ형12례，Ⅲ형6례，미분형18례；M RC T분형：I형26례，Ⅱ형14례，Ⅲ형14례，미분형1례。여림상분형비교，4례M RC T진단위II형，이림상진단위Ⅲ형，2례MRCT진단위Ⅱ형，림상진단위I형。척골관돌골절MRCT분형민감성고우CR（ P ＜0．05）。결론 CR대주관절골절구유교고적검출솔，단진단준학성불고，대척골관돌골절검출솔급골절분형민감성저우MRCT ；대CR진단주관절골절우기부의척골관돌골절병례응행M RC T검사，대감소루진급지도림상제정합리적치료방법의의중대。
Objective To evaluate diagnostic value of two methods of CR and CT for the ulnar coronoid and application value of Negan‐Morrey classification method .Methods A retrospective analysis of CR and CT images of 55 cases with el‐bow ulnar coronoid was performed .Taking the final clinical diagnosis as the gold standard to be a comparison ,we analysed the diagnostic accuracy of fracture at any part of the elbow by CR and CT ,elbow fracture detection rate ,the detection rate of ulna coronoid ,and diagnostic sensitivity of "Negan‐Morrey classification Law".Results Among 55 cases of elbow frac‐ture ,33 cases were diagnosed as fracture and 22 cases were not matched by CR ,the diagnostic accuracy of CR was 60% ;54 cases were diagnosed as fracture and 1 case was not matched by CT ,the diagnostic accuracy of CT was 98 .2% ,CT was of higher diagnostic accuracy for elbow fracture than CR (χ2=24 .24 ,P<0 .05) .Taking "at least one elbow fracture was detected"as standard ,CR detected 41 cases ,14 cases was missed ,detection rate was 74.55% ;MRCT detected all (100% ) .Detection rate of CT for elbow fracture was higher than CR (χ2=16 .04 ,P<0 .05) .Only analysing ulna coro‐noid fracture ,CR detected 37 cases and 18 cases were negative ,the detection rate was 67.27% ;CT detected all (100% ) . The detection rate of CT for ulna coronoid was higher than CR (χ2=21 .52 ,P <0 .05) .Ulna coronoid classification by CR:type I was 19 cases ,type II 12 cases ,type III 6 cases ,un‐divided 18 cases ;by CT :type I was 26 cases ,type II 14 cases ,type III 14 cases .Compared with clinic classification ,4 cases were diagnosed as type II by CT ,but was divided into type III by clinic classification ,and 2 cases were diagnosed as type II by CT ,but was divided into type I by clinic classifica‐tion .CT was more sensitive than CR at classifying of Ulna coronoid fracture ( P<0 .05) .Conclusion CR had a high de‐tection rate for elbow fracture ,low diagnostic accuracy on the ulnar coronoid fractures and a lower fracture type detection rate ,and is sensitivie than CT .For those CR diagnosed elbow fractures ,especially for the diagnosis of cases of suspected ulnar coronoid ,CT examination should be performed .It was of great significance in reducing misdiagnosis and clinical de‐velopment of rational treatment .