多层螺旋CT及其三维重组诊断地震压砸伤胸部骨折
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摘要
目的探讨MSCT及其三维重组技术对地震压砸伤患者胸部骨折的诊断价值。方法回顾性分析135例地震压砸伤患者胸部骨折的MSCT表现和三维重组图像的诊断优势。结果135例患者共发现肋骨骨折100例,严重肋骨骨折包括第1、2肋骨骨折50例,3支或3支以上肋骨骨折81例和连枷胸36例;非肋骨骨折包括胸椎、胸骨、肩胛骨和锁骨骨折共59例,非肋骨骨折出现与否与严重肋骨骨折的发生之间有明显相关性。结论地震所造成的压砸性胸部骨折中,严重肋骨骨折的发生率高。非肋骨骨折与严重肋骨骨折的发生之间有明显相关性,可以作为判断患者胸部压砸伤严重程度的良好指标。MSCT三维重组对胸部细微骨折的诊断价值高于常规轴位图像。
Objective To evaluate the diagnostic value of multi-slice spiral computed tomography(MSCT)with three-dimensional reformations in crush thoracic fractures arising from the Wenchuan earthquake.Methods MSCT features of thoracic fractures of 135 patients and the advantage of three-dimensional reformated images were retrospectively analyzed.Results Among 135 patients,100 patients with rib fractures were detected by MSCT,including 50 cases with the first and/or second rib fractures,81 cases with 3 or more rib fractures,and 36 cases with flail chest.Bone fractures involved thoracic spine,sternum,scapula and/or clavicle were detected in 59 cases,which correlated well with severe rib fractures.Conclusion In the patients with crush thoracic fractures caused by earthquake,the incidence of severe rib fractures was rather high.Accordingly,bone fractures involved thoracic spine,sternum,scapula and/or clavicle correlated well with severe rib fractures,which may be useful for indicating the severity of crush thoracic injuries.Three-dimension reformation images can provide more diagnostic confidence in tiny bone fractures than conventional axial MSCT images.
Objective To evaluate the diagnostic value of multi-slice spiral computed tomography(MSCT)with three-dimensional reformations in crush thoracic fractures arising from the Wenchuan earthquake.Methods MSCT features of thoracic fractures of 135 patients and the advantage of three-dimensional reformated images were retrospectively analyzed.Results Among 135 patients,100 patients with rib fractures were detected by MSCT,including 50 cases with the first and/or second rib fractures,81 cases with 3 or more rib fractures,and 36 cases with flail chest.Bone fractures involved thoracic spine,sternum,scapula and/or clavicle were detected in 59 cases,which correlated well with severe rib fractures.Conclusion In the patients with crush thoracic fractures caused by earthquake,the incidence of severe rib fractures was rather high.Accordingly,bone fractures involved thoracic spine,sternum,scapula and/or clavicle correlated well with severe rib fractures,which may be useful for indicating the severity of crush thoracic injuries.Three-dimension reformation images can provide more diagnostic confidence in tiny bone fractures than conventional axial MSCT images.
引文
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[10]Zhang ZF,Dai SP,Dai JR,et al.Clinical value of improved spi-ral CTcostal bone scanning method in the diagnosis of rib frac-ture.J Chin Clin Med Imaging,2005,16(12):717-719.张兆福,戴世鹏,代景儒,等.肋骨骨折螺旋CT扫描的改良方法及应用价值.中国临床医学影像杂志,2005,16(12):717-719.
[11]Vialle LR,Vialle E.Thoracic spine fractures.Injury,2005,36(Suppl2):B65-72.
[12]Matthias T,Mark S,Suzanne M,et al.The use of chest compu-ted tomography versus chest X-ray in patients with major blunt trauma.Injury,2007,38(1):43-47.
[13]Knobloch K,Wagner S,Haasper C,et al.Sternal fractures are frequent among polytraumatised patients following high decelera-tion velocitiesin a severe vehicle crash.Injury,2008,39(1):36-43.
[2]Freixinet J,Beltran J,Rodriguez PM,et al.Indicators of severity in chest trauma.Arch Bronconeumol,2008,44(5):257-262.
[3]Ghodsi SM,Zargar M,Khaji A,et al.Chest injury in victims of Bamearthquake.Chin J Traumatol,2006,9(6):345-348.
[4]Ozdogan S,Hocaoglu A,Caglayan B,et al.Thorax andlunginju-ries arising fromthe two earthquakes in Turkey in1999.Chest,2001,120(4):1163-1166.
[5]Lomoschitz FM,Eisenhuber E,Linnau KF,et al.Imaging of chest trauma:radiological patterns of injury and diagnostic algo-rithms.Eur J Radiol,2003,48(1):61-70.
[6]Sirmali M,Turut H,Topcu S,et al.Acomprehensive analysis of traumatic rib fractures:morbidity,mortality and management.Eur J Cardiothorac Surg,2003,24(1):133-138.
[7]Bastos R,Calhoon J H,Baisden CE.Flail chest and pul monary contusion.Semin Thorac Cardiovasc Surg,2008,20(1):39-45.
[8]Livoni JP,Barcia TC.Fracture of the first and second rib:inci-dence of vascular injury relative to type of fracture.Radiology,1982,145(1):31-33.
[9]Livingston DH,Shogan B,John P,et al.CT diagnosis of Rib fractures and the prediction of acute respiratory failure.J Trauma,2008,64(4):905-911.
[10]Zhang ZF,Dai SP,Dai JR,et al.Clinical value of improved spi-ral CTcostal bone scanning method in the diagnosis of rib frac-ture.J Chin Clin Med Imaging,2005,16(12):717-719.张兆福,戴世鹏,代景儒,等.肋骨骨折螺旋CT扫描的改良方法及应用价值.中国临床医学影像杂志,2005,16(12):717-719.
[11]Vialle LR,Vialle E.Thoracic spine fractures.Injury,2005,36(Suppl2):B65-72.
[12]Matthias T,Mark S,Suzanne M,et al.The use of chest compu-ted tomography versus chest X-ray in patients with major blunt trauma.Injury,2007,38(1):43-47.
[13]Knobloch K,Wagner S,Haasper C,et al.Sternal fractures are frequent among polytraumatised patients following high decelera-tion velocitiesin a severe vehicle crash.Injury,2008,39(1):36-43.
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