Zhou Yijun,Yang Ge,Bai Xiaoan,et al.Comparative study of midpoint line of proxima-distal epiphyseal of radius and traditional radiocapitellar in diagnosis of Monteggia’s fracture in children[J].Journal of Clinical Pediatric Surgery,2023,22(08):773-777.[doi:10.3760/cma.j.cn101785-202307046-014]
桡骨远近端骺板中点连线和传统桡骨肱骨小头线诊断儿童孟氏骨折的对比研究
- Title:
- Comparative study of midpoint line of proxima-distal epiphyseal of radius and traditional radiocapitellar in diagnosis of Monteggia’s fracture in children
- 摘要:
- 目的 为X线检查诊断儿童孟氏骨折寻找一种除传统桡骨肱骨小头线（radiocapitellar lines，RCL）以外的新评价方法。方法 本研究为回顾性研究，收集常德市第一人民医院及湖南省儿童医院2020年4月至2023年1月接诊的100例疑似儿童孟氏骨折患儿作为研究对象。患儿均完善尺桡骨正位、侧位X线片（包含双关节），对可疑患儿进一步通过肘关节MRI或肘关节造影确诊。在每张正、侧位X线片上画出传统的RCL （沿桡骨颈长轴中心线，即N线；沿桡骨干纵轴线，即S线）和桡骨远、近端骺板中点的连线（P线）。对比RCL和P线诊断孟氏骨折的准确率。结果 P线与金标准（肘关节MRI或造影）比较，真阳性为78例、假阳性为0例、真阴性为16例、假阴性为6例，P线诊断孟氏骨折的符合率为94%（94/100），漏诊率为7.14%（6/84），误诊率为0；N线与金标准比较，真阳性为82例、假阳性为16例、真阴性为0例、假阴性为2例，N线诊断孟氏骨折的符合率为82%（82/100），漏诊率为2.38%（2/84），误诊率为100%（16/16）；S线与金标准比较，真阳性为54例、假阳性为0例、真阴性为16例、假阴性为30例，S线诊断孟氏骨折的符合率为70%（70/100）、漏诊率35.71%（30/84）、误诊率为0。P线诊断孟氏骨折的Kappa值为0.806，N线诊断孟氏骨折的Kappa值为-0.037、S线诊断孟氏骨折的Kappa值为0.365。结论 采用X线检查初步诊断孟氏骨折中，P线的诊断价值较N线和S线更可靠。
- Abstract:
- Objective To seek a novel radiographic diagnostic method for Monteggia fracture in children other than traditional radiocapitellar line (RCL).Methods From April 2020 to January 2023, the relevant clinical data were retrospectively reviewed for 100 hospitalized children suspected with Monteggia fracture at both hospitals.Anteroposterior and lateral radiographs of ulna and radius (including double joints) were examined.And the lesions were confirmed by elbow magnetic resonance imaging (MRI) or arthrography.Traditional RCL (N-line:center line along long axis of radial neck; S-line:Along longitudinal axis of radial shaft) and midpoint line of proximal-distal radial epiphysis (P-line) were drawn on each anteroposterior and lateral radiological films.The accuracy of RCL and P line in the diagnosis of Monteggia fracture was compared.Results When P-line was compared with the gold standard, the number of true positive cases was 78, the number of false positive cases 0, the number of true negative cases 16 and the number of false negative cases 6.The diagnostic coincidence rate of P line was 94%(94/100), the diagnostic omission rate 7.14%(6/84) and the misdiagnosis rate 0.When N-line was compared with the gold standard, the number of true positive cases was 82, the number of false positive cases 16, the number of true negative cases 0 and the number of false negative cases 2.The diagnostic coincidence rate of N-line was 82%(82/100), the diagnostic omission rate 2.38%(2/84) and the misdiagnostic rate 100.00%(16/16).When S-line was compared with the gold standard, the number of true positive cases was 54, the number of false positive cases 0, the number of true negative cases 16 and and the number of false negative cases 30.The diagnostic coincidence rate of S line was 70%(70/100), diagnostic omission rate 35.71%(30/84) and misdiagnostic rate 0.Diagnostic Kappa value of P line was 0.806, N-line -0.037 and S line 0.365.Conclusion The value of P line is more reliable than N/S line in the initial radiographic diagnosis of Monteggia fracture.
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备注/Memo
收稿日期:2022-07-24。
基金项目:湖南儿科医联体专项科研基金（2021hnekyltB04）
通讯作者:梅海波,Email:meihaibo@sohu.com