| 隐匿性跟骨前结节骨折CT特征并漏诊原因分析 |
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投稿时间：2019-08-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 蒋际钊 |
JIANG Ji-zhao |
广东省中医院珠海医院骨六科, 广东 珠海 519015 |
The 6th Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai 519015, Guandong, China |
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| 张梅刃 |
ZHANG Mei-ren |
广东省中医院珠海医院骨六科, 广东 珠海 519015 |
The 6th Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai 519015, Guandong, China |
zhangmeiren@aliyun.com |
| 黄培楷 |
HUANG Pei-kai |
广东省中医院珠海医院放射科, 广东 珠海 519015 |
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| 黄乐生 |
HUANG Le-sheng |
广东省中医院珠海医院放射科, 广东 珠海 519015 |
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| 期刊信息：《中国骨伤》2019年，第32卷，第11期，第1057-1062页 |
| DOI：10.3969/j.issn.1003-0034.2019.11.016 |
| 基金项目: |
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中文摘要:
目的：探讨隐匿性跟骨前结节骨折的CT特征和临床漏诊原因。
方法：回顾性分析2013年7月至2018年11月确诊的13例隐匿性跟骨前结节骨折患者的临床资料，其中男2例，女11例，年龄22~54岁；根据患者病历、X线片、CT资料分析骨折类型、骨折移位情况、骨折线方向、骨折块大小、是否合并跗骨联合、是否合并其他骨折、是否漏诊、受伤至明确诊断时间以及治疗情况和骨折愈合情况。
结果：13例患者经CT检查后确诊为跟骨前结节骨折，Degan骨折分型：Ⅰ型9例，Ⅱ型4例；移位4例，无移位的9例；CT水平面骨折线横行12例，斜行1例，骨折块大小0.40~1.72 cm；CT矢状面骨折线垂直行12例，斜行1例，骨折块大小0.10~0.59 cm。所有患者未合并跟距或跟舟骨桥；单纯跟骨前结节骨折6例，7例合并其他部分骨折；8例患者漏诊；受伤至明确诊断时间0~21 d；9例Ⅰ型骨折采用保守治疗，6例愈合，3例骨折不愈合，均发生于水平面骨折线长度<1 cm的患者；4例Ⅱ型骨折也未行手术治疗，不论骨折块的大小，4例均未愈合。
结论：隐匿性跟骨前结节骨折在临床中有较高的漏诊率，其CT特征为骨折线在水平面多横行和矢状面多垂直行，在矢状面骨折块小，而在水平面骨折块则表现大小不等；CT水平面骨折块<1 cm的Ⅰ和Ⅱ型骨折保守治疗出现骨折不愈合率高。 |
| 【关键词】跟骨 骨折 体层摄影术,X线计算机 漏诊 |
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| CT imaging features and misdiagnosis analysis of occult anterior calcaneal process fracture |
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ABSTRACT
Objective: To explore CT imaging features and reason for missed diagnosis of clinical practice of occult anterior calcaneal process fracture.
Methods: From July 2013 to November 2018,the clinical data of 13 patients with occult an anterior calcaneal process fracture were retrospectively analyzed,including 2 males and 11 females,aged from 22 to 54 years old. Classification of fracture,displacement of fracture,direction of fracture line,size of fracture,with or without tarsal coalition,other fractures and misdiagnosis,the time from injury to diagnosis,condition of treatment and fracture healing were observed according to case history,data of X-ray and CT.
Results: Thirteen patients were diagnosed as occult anterior calcaneal process fracture after CT examination. According to Degan classification,9 patients were typeⅠ,4 patients were typeⅡ;4 patients were occurred displacement,and 9 patients did not occurred displacement. On the horizontally CT,fracture line of 12 patients showed transverse,1 patient oblique,and the size of fracture ranged from 0.40 to 1.72 cm;while on the sagittal view,fracture line of 12 patients showed vertical,1 patient oblique,and the size of fracture ranged from 0.10 to 0.59 cm. No patients combined with talocalcaneal and scaphoid bridge. Six patients were simple anterior calcaneal process fracture,7 patients combined with other fractures. Eight patients were misdiagnosed. The time from injury to diagnose ranged from 0 to 21 days. Nine patients with typeⅠwere performed conservative treatment,6 patients healed well and 3 patients with fracture line less than 1 cm on horizontally view occurred fracture nonunion. Four patients with typeⅡdid not perform operation,and fracture were not union,regardless of fracture size.
Conclusion: Occult anterior calcaneal process fracture have high rate of missed diagnosis in clinical practice. CT imaging features of fracture showed that most fracture line were transverse on CT horizontal plane while vertical on CT sagittal plane,as well as small side of fragment on CT sagittal plane with differernt sizes of fragment on CT horizontal plane;typeⅠfracture with fragment less than 1 cm on CT horizontal plane and typeⅡboth have high rate of nonunion while treated with conservative treatment. |
| KEY WORDS Calcaneus Fractures Tomography,X-ray computed Misdiagnosis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 蒋际钊,张梅刃,黄培楷,黄乐生.隐匿性跟骨前结节骨折CT特征并漏诊原因分析[J].中国骨伤,2019,32(11):1057~1062 |
| 英文格式: | JIANG Ji-zhao,ZHANG Mei-ren,HUANG Pei-kai,HUANG Le-sheng.CT imaging features and misdiagnosis analysis of occult anterior calcaneal process fracture[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(11):1057~1062 |
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