A Comparative Study Of X－ray Plain Film,CT And Three－dimensional CT In The Diagnosis Of Complex Bone Andjoint Trauma

To explore the applicative merit of three-dimensional imaging and multiplanar reconstruction of multislice spiral computed tomography (MSCT) in complex trauma of bone and joint, compare with X-ray plain film and CT, evaluate their accuracy and diagnostic valuation in the diagnosis of complicated fractures. Methods: 48 patients and their 57 regions of trauma were all examined with X-ray plain film, CT and 3DCT. Their volumetric data of CT were transferred to working station of the computer, three dimensional images of bone and joint were reconstructed with two forms, surface shading display(SSD) and multiplanar reconstruction (MPR). The accuracy and diagnostic valuation of three methods were analyzed and evaluated, the clinical significance of 3DCT imaging in the application of complex bone and joint trauma was discussed. Results: The sensitivity, specificity and positive predictive value of CT and 3DCT are all higher than X-ray plain film. There has little mistaken diagnosis and omissible diagnosis. False positive and false negative of x-ray plain film are much higher than CT and 3DCT.In order to increase the accuracy of diagnosis, further examination of CT or/and 3DCT should be done in those clinically suspected patients, though their x-ray plain film showed no fracture orambiguous fracture. CT and 3DCT are obviously superior to x-ray plain film, and there is significant statistic difference between them (p<0.01) when youden's index(YI) is used to compare the diagnostic accuracy of three methods. There is no significant statistic difference between CT and 3DCT(p>0.05). The combination of SSD, MPR and dissected technique of joint can clearly show all the details and solid morphology of complex fractures. MPR is superior in displaying the direction and displacement of freacture line. SSD can better show space change of bone structure, displacement of fracture fragments and joint dislocation. Conclusion: Three-dimensional imaging of MSCT has very high applicative valuation in the diagnosis of complex bone and joint trauma, it is an effective supplement to x-ray plain film and CT. The combination of 3DCT, joint-dissected technique and image-revolving technique can display all the details of any complex fracture, get the effect of watching anatomic sample. They are helpful in determining treatment plan, selecting methods of operation and inner fixation, decreasing trauma and fault of operation.