摘要目的 探讨多排螺旋CT在胸腹部损伤中的诊断价值.方法 选择运城市第一医院2015 年1月至2018年1月收治的急性创伤患者200例为研究对象,对患者进行胸腹部X线检查、多排螺旋CT检查,以临床综合诊断结果为参照,计算和比较X线、螺旋CT对胸腹部损伤诊断的灵敏度、特异度、准确率,并比较X线、螺旋CT对肋骨骨折、胸腹腔内脏器损伤的诊断符合率.采用一致性检验,分析X线、螺旋CT诊断结果与临床综合诊断结果的一致性.结果 X线对胸腹部损伤诊断的灵敏度、特异度、准确率分别为89.58% (129/144)、85. 93% (47/56)、88. 00% (176/200),螺旋 CT 诊断的灵敏度、特异度、准确率分别为97.22% (140/144)、96. 43% (54/56)、97. 00% (194/200),螺旋CT对胸腹部损伤诊断的灵敏度、特异度、准确率均高于X线(χ2 =6. 818、4. 940、11. 676,均P<0. 05).螺旋CT对肋骨骨折、肺挫伤、肝挫伤、脾破裂、胰腺损伤、腹膜损伤的诊断符合率分别为 97. 67% ( 84/86 )、97. 06% ( 33/34)、100. 00% ( 25/25 )、100. 00% ( 27/27 )、100.00% (21/21)、97. 96% (48/49),均高于 X 线( χ2 =5. 733、3. 981、4. 348、5. 510、4. 421、5. 995,均 P <0.05).经一致性检验,螺旋CT与临床综合诊断结果之间的一致性良好(Kappa=0. 747),而X线与临床综合诊断结果之间的一致性中等(Kappa=0. 563).结论 采用多排螺旋CT检查可对胸腹部损伤予以准确诊断,还可对肋骨骨折、胸腹腔内脏器损伤等伤情进行明确诊断,具有较高的诊断价值.

abstractsObjective To evaluate the diagnostic value of multi-slice spiral CT in thoracic and abdominal joint injury. Methods From January 2015 to January 2018,200 patients with acute trauma were selected in the First Hospital of Yuncheng. Chest and abdomen X - ray examination and multi - row spiral CT examination were performed. The diagnostic sensitivity,specificity and accuracy of X-ray and spiral CT in the diagnosis of thoracoab-dominal joint injury were calculated and compared. The coincidence rate of X-ray and spiral CT in diagnosis of rib fracture and intrathoracic and abdominal organ injury was compared. Consistency test was used to analyze the consistency between X -ray, spiral CT diagnosis and clinical comprehensive diagnosis. Results The sensitivity, specificity and accuracy of X - ray in the diagnosis of chest joint damage were 89. 58% ( 129/144 ),85. 93% (47/56),88. 00% (176/200),respectively,which were lower than those of spiral CT[97. 22% (140/144),96. 43% (54/56),97. 00% (194/200)] ( χ2 =6. 818,4. 940,11. 676,all P <0. 05). The diagnostic coincidence rates of spiral CT for rib fracture,lung contusion,liver contusion,splenic rupture,pancreas injury and peritoneal injury were 97. 67% (84/86 ), 97. 06% ( 33/34 ), 100. 00% ( 25/25 ), 100. 00% ( 27/27 ), 100. 00% ( 21/21 ), 97. 96% (48/49),which were higher than those of X-ray(χ2 =5. 733,3. 981,4. 348,5. 510,4. 421,5. 995,all P<0. 05). After consistency test, there was good consistency between spiral CT and clinical comprehensive diagnostic results(Kappa=0. 747),and medium consistency between X - ray and clinical comprehensive diagnostic results (Kappa=0. 563). Conclusion Multi -row spiral CT can be used to accurately diagnose the combined injury of chest and abdomen,as well as to identify the fracture of rib and the injury of internal organs and organs in the chest and abdominal cavity.