不同影像学检查在髋臼骨折诊断中的价值

目的探讨X线片、CT平扫及CT三维重建在髋臼骨折诊断中的价值。方法1997年11月～2004年3月对74例髋臼骨折患者拍前后位、多方位即闭孔斜位、髂骨斜位、骨盆出、入口位X线片,其中57例行CT平扫,17例行CT三维重建。分别计算并比较各种方法对髋臼骨折的检出率,同时根据影像学所见进行诊断、分型,并在术中验证得出分型符合率后进行对比。结果骨折检出率:前后位X线片为90.54%,多方位X线片为97.30%,CT平扫为98.25%,CT三维重建为100%;其分型符合率分别为41.79%,97.22%,100%,100%。结论传统的前后位与多方位X线片为髋臼骨折诊断中经济实用的首选方法,CT平扫与三维重建可提高诊断率,并对准确分型、制定合理的治疗方案起关键作用。     

骨盆创伤的CT检查(附50例CT与X线平片检查对照)

目的分析急性骨盆损伤的CT征象,评价CT在骨盆损伤诊断中的应用价值和局限性。方法50例骨盆损伤的患者进行X线、薄层CT检查,分析CT检查征象,并与X线平片对照。结果50例中CT发现骨盆各骨骨折157处,X线显示骨折113处,X线平片及CT的检出率差异有显著性意义(χ2=38·72,P<0·01);CT发现关节脱位27处,X线显示脱位16处,X线平片及CT的检出率差异有显著性意义(χ2=9·09,P<0·01)。X线平片中有3处阳性征象CT检查未能显示。结论CT检查在显示骨、关节的骨折、脱位,盆腔脏器及软组织的损伤,判断骨盆骨折的严重程度等方面优于X线平片,并适合多发伤及危重患者同时进行多项检查时应用,为救治严重创伤患者的一种快速、准确的放射检查手段。     

骨盆骨折X线表现及轴向CT相关性研究

目的探讨骨盆骨折时骨盆前后位、出口位、入口位X线表现及轴向CT表现的差异,确定不同部位骨盆骨折投照的最佳位置。方法回顾性分析了55例骨盆骨折患者骨盆前后位、出口位、入口位X线片及轴向CT片。将骨折表现程度分为四个等级。分别观测同一部位骨折在不同位置X线片及CT上的表现程度。结果耻骨联合分离程度在各种投照位置上无明显差异。耻骨支、耻骨体、坐骨、骶孔和L5横突,移位程度在出口位上表现最明显。骶髂关节分离,骶骨翼、髂嵴骨折在入口位上表现最明显。骶骨压缩骨折,半骨盆向后移位,水平旋转不稳在入口位X线片上最明显。垂直旋转不稳在出口位片上最明显。CT在诊断骶髂关节分离及骶骨骨折有独特价值。结论骨盆骨折应首先摄前后位X线片,根据骨折部位,进一步摄入口位、出口位X线片。并根据骨折的表现判断其稳定性,指导临床治疗。CT在诊断骶骨骨折,骶髂关节分离有独特价值。     

螺旋CT重建技术在骨盆环骨折中的诊治价值

目的:探讨螺旋CT二维多平面重建(MPR)、三维重建(3D)对骨盆环骨折的诊断、分型及治疗的临床价值。方法:回顾性分析2004年4月至2009年4月收治的有完整的X线DR(digital radiography)片、螺旋CT片影像资料的57例骨盆环骨折患者,根据Tile分类,本组病例A型38例,B型12例,C型7例。对A型患者采取保守治疗,对B、C型患者全部采取手术治疗,根据骨折移位情况,采用开放复位内固定或经皮行骶髂关节空心螺钉内固定术。术后3d～27个月内进行随访,利用螺旋CT检查进行术后疗效评估,对其术前术后的DR片、螺旋CT的3D、MPR的重建图像进行对照分析。结果:57例骨盆环骨折患者中,5例骨盆后环骨折患者的X线DR片诊断为可疑骨折,9例骨盆后环骨折X线DR片漏诊,3例骨盆前环骨折患者的X线DR片诊断为可疑骨折,3例骨盆前环骨折患者的X线DR片漏诊,后经螺旋CT检查予以修正。术后影像学评价优15例,良3例,差1例;临床评价优16例,良3例。结论:螺旋CT的MPR、3D的重建图像对骨盆环骨折的诊断、分型及临床治疗评估具有重要的临床价值。     

CT与X线检查对桡骨头细微骨折的诊断效果比较研究

目的研究分析不同影像学方法对桡骨头细微性骨折的诊断作用价值。方法选取2016年1月至2017年6月本院收治的怀疑桡骨头骨折患者92例,经正、侧位X线片检查未发现骨折,经CT及斜位X线检查及随访桡骨细微性骨折病例的相关资料共69份。观察并记录创伤后首次、治疗后1个月复查时桡骨头细微骨折正位、侧位、斜位的X线检查、CT检查诊断率,对两种检查获得结果进行比较研究。结果创伤后首次行X线及CT检查结果比较中,斜位X线片诊断率显著高于正、侧位X线检查(χ~2=26.495),CT检查诊断显著高于正、侧位X线检查(χ~2=35.196);CT检查诊断率略高于斜位X线检查(χ~2=6.7034),差异具有统计学意义(P0.05);CT及斜位X线片诊断率明显高于正位、侧位X线检查(χ~2=8.9964、χ~2=7.4986,P0.05);复查时正位、侧位及斜位X线检查诊断率均明显高于创伤后首次检查诊断率(P0.05);创伤后首次CT检查与治疗后1个月复查诊断率无明显差异(P0.05)。结论 CT与斜位X线检查均是诊断桡骨头细微性骨折的有效影像学方法,极大地提高了骨折的诊断率,另外对怀疑桡骨头骨折者可首选斜位X线检查,适合临床医师选择应用。     

螺旋CT在骨盆后环骨折的诊断作用

目的:探讨螺旋CT在骨盆后环骨折诊断中的意义。方法:31例骨盆后环患者均行骨盆X线片和螺旋CT三维重建。结果:31例经X线片做出诊断25例,漏诊2例(占6.5%),可疑4例(占12.9%),经螺旋CT检查后修正诊断,螺旋CT三维重建片均清楚显示病变的部位和骨折的立体细节。结论:螺旋CT检查有助于确定骨盆后环骨折的分型,有利于选择合理的内固定方法。     

胫骨平台骨折患者行CT三维重建和X线检查的诊断价值比较研究

目的研究分析胫骨平台骨折患者分别行X线片检查和CT三维重建,对比分析两种影像检查对胫骨平台骨折的整体临床价值。方法选取2016年1月至2017年6月收治的胫骨平台骨折患者174例,对其分别行X线片、CT三维重建检查,X线及CT检查图像均由1名本院副高级别影像科医师及1名副高级骨科医师共同阅片并评估。结果 CT三维重建检查结果与手术诊断结果一致,诊断率为100.0%。X线检查结果中,174例胫骨平台骨折患者共确诊病例为141例,诊断率为81.03%,CT三维重建检查诊断率明显高于X线检查,差异具有统计学意义(P0.05)。结论 CT三维重建技术对胫骨平台骨折的诊断优势较为突出,重建处理后可通过多角度显示胫骨平台损伤状态,有利于治疗医师掌握骨折移位的方向、严重度及塌陷情况,骨折分型判断标准,利于临床治疗方案的制定。     

螺旋CT三维重建在骨盆后环损伤的应用

目的探讨螺旋CT三维重建对骨盆后环骨折的诊断及治疗上的临床意义。方法2002年3月～2003年8月,对骨盆骨折且有完整X线平片和CT三维重建资料的19例患者进行回顾性分析,并对两种检查方法的结果进行比较。结果19例患者中,9例X线片漏诊或可疑,经三维CT检查后修正诊断。对于骶髂关节部分及前后分离、骶髂关节内碎骨、骶髂关节髂骨唇或骶骨唇骨折、骶骨骨折及复杂粉碎性的骨盆后环骨折,三维CT较X线片有明显的优势,能多层次清晰显示骨盆后环的骨折形态。结论三维CT检查对骨盆后环骨折的诊断、分类及指导治疗具有重要的意义和作用。     

CT三维重建在股骨转子间骨折AO分型中的价值

目的探讨CT三维重建在股骨转子间骨折AO分型准确性、一致性以及稳定性评估中的优越性。方法由3名医生阅读术前X线片,并按AO分型方法进行骨折分型、稳定性评估并讨论获得一致结论;同样方法阅读术前CT三维重建图像,获得分型、稳定性评估及一致结论。对两者结论不同的病例由3名医生共同阅读X线片及CT三维重建图像,经讨论得出一致分型及稳定性评估结论,加上基于X线片和CT三维重建相同的结论作为金标准。结果 3名医生基于CT三维重建AO分型的一致性、分型准确性均高于X线片。3名医生稳定性评估准确率:基于X线片不稳定性骨折比例均明显低于金标准,差异均有统计学意义(P 0. 01);基于CT三维重建比例与金标准比较差异均无统计学意义(P 0. 05)。结论采用CT三维重建在股骨转子间骨折分型准确性、一致性以及稳定性评估明显优于X线片。     

隐匿性骨盆后环损伤的影像学表现及临床意义

目的：探讨临床容易忽视的隐匿性骨盆后环损伤的影像学表现及其临床意义。方法：调阅2003年1月至2008年1月我院影像学资料完整的178例骨盆创伤病历，发现21例骨盆CR正位片显示后环正常或疑似损伤，调阅其骨盆螺旋CT发现其中17例均有骨盆后环损伤，其中男11例，女6例；年龄19-71岁，平均34．7岁。螺旋CT检查方法：平描层厚3mm，同时做冠状面、矢状面及骶骨曲面重建。对CR片及CT图像进行横向对照，结合患者临床情况进行分析研究。结果：17例中CR正位片显示骨盆前环耻、坐骨支骨折或耻骨联合损伤。CT多维重建显示后环骶骨骨折DenisⅠ型5例、Ⅱ型5例、Ⅲ型2例，骶髂关节分离移位1例，骶骨合并髂骨后部骨折4例。按受伤机制分析，17例漏诊患者中15例属于侧方挤压暴力导致的内旋损伤，2例属于前后挤压暴力导致的外旋损伤，按Young—Burgess分型：LCⅠ型11例、Ⅱ型4例和APCⅠ型2例；按Tlie和AO分型均为B型旋转不稳定。资料CR正位片骨盆后环骨折确诊率为89％。螺旋CT横断面、冠状面、矢状面和骶骨曲面4个面的重建同时应用，对微细骨折检出率为100％。结论：螺旋CT4个面的重建同时应用是确诊骨盆后环骨折的“金标准”，为更精确的诊断提供科学依据，降低并发症，减少漏诊率。     

骨盆创伤的CT检查(附50例CT与平片检查对照)

为探讨关于复合性创伤快速准确的检查方法,提高骨盆创伤的检出率。对经CT扫描并有平片检查的骨盆创伤50例(其中30例为多部位复合伤),分析CT检查征象,并与平片对照。结果发现50例中CT发现骨盆各骨骨折157处,关节脱位20处。平片分别为CT检出率的71.9％和80％。平片中有3处阳性征象CT检查未能显示。认为CT检查对于骨、关节及软组织损伤的显示优于平片检查,并适合复合伤及危重患者同时进行多项检查时应用,为救治严重创伤患者的一个快速、准确地放射检查手段。     

急性颈椎损伤的CT诊断

目的分析急性颈椎损伤的CT征象,评价CT在急性颈椎损伤诊断中的价值及限度。方法78例颈椎外伤患者行X线片、薄层CT及三维重建检查,并进行对照分析。结果经影像学诊断60例急性颈椎损伤CT确诊59例,1例CT阴性而由X线片确诊。X线片与CT的骨折检出率分别为53.3%和98.3%,两者差异有非常显著性意义P<0.01。结论在急性颈椎损伤中CT能安全、快捷地对骨折、脱位、外伤性椎管狭窄等做出全面准确的诊断。但CT扫描也存在一些局限性应用中应该将X线片与CT检查结合起来才能提高诊断水平。     

Comminuted pelvic ring disruption in toddlers: management of a rare injury

Pediatric pelvic fractures are rare injuries. The clinical management, classification, and operative treatment of this type of injury was presented in two toddlers ranging in age from 1 to 3 years. The CT examination proved to be the most reliable diagnostic tool for the assessment of the fracture morphology. The findings of the CT examination provide the possibility for an exact classification and operative planning. The surgical treatment was performed with the AO instrumentation for small fragments by using the approved standard approaches of adult surgery. The postoperative management has to be adapted to the physiology of the children. It is important to remove the osteosynthesis material in due time to avoid the risk of epiphysiodesis at the pelvis. To detect late sequelae of the trauma, follow-up should be performed regularly until growth is completed.     

The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures

BACKGROUND: Computed tomographic (CT) scanning is sensitive in detecting pelvic fractures in the pediatric patient. Pelvic fractures in the pediatric population rarely require emergent intervention, thus providing time to obtain the optimal imaging study. The objective of this study was to compare pelvic radiographs and abdominal pelvic CT scans of all pediatric trauma patients with pelvic injury to determine the role of pelvic imaging in the immediate trauma resuscitation. METHODS: A retrospective review was performed of pediatric patients (age < 18 years) with a pelvic fracture identified from the registry of a Level I pediatric trauma center for the period 1993 to 2001. Patients with a documented pelvic injury and both a pelvic CT scan and pelvic radiograph available for review were extracted for analysis. For this study, all films were re-reviewed by an attending pediatric radiologist, and the abnormalities were categorized by the area of injury. The data were comparatively analyzed according to the area of injury and the soft tissue findings. RESULTS: For the 8-year period, 130 pediatric patients with a pelvic fracture were identified, including 103 patients with both a pelvic CT scan and radiographs. Of the 151 fractures identified by pelvic CT scan, 81 were also identified by the pelvic radiograph (54%). There were 38 soft tissue hematomas noted by pelvic CT scan and only 2 identified by the pelvic radiograph. The greatest discrepancy was noted in comparison of the sacral region (16 abnormal pelvic CT scans vs. 3 abnormal radiographs); the least discrepancy was noted in the evaluation of the hip (6 abnormal pelvic CT scans vs. 5 abnormal radiographs). CONCLUSION: The pelvic radiograph lacked the sensitivity of the pelvic CT scan for detecting pelvic fractures in all anatomic areas evaluated. Pelvic CT scan also offers additional information regarding soft tissue injury not available on most pelvic radiographs. In the trauma patient that will undergo abdominopelvic CT scanning as part of the trauma evaluation, a pelvic radiograph may be superfluous. Screening pelvic radiography should be reserved for the rare unstable patient or the patient in whom an abdominopelvic CT scan is not otherwise indicated.     

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

Objective：Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray （CXR） is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy （CT） in hemodynamically stable patients with blunt chest trauma.Methods：Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results：Two hundreds patients （84% male and 16% female） were included with a mean age of（37.9±13.7） years.Rib fracture was the most common finding of CXR （12.5%） and CT scan （25.5%）.The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion：Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.     

Clinical effectiveness of the physical examination in diagnosis of posterior pelvic ring injuries

OBJECTIVE: To determine if physical examination (PE) of the posterior pelvis in awake and alert trauma patients with known pelvic ring injuries can accurately predict a potentially unstable posterior ring injury and guide the use of computed tomography (CT) more effectively. DESIGN: Patients with pelvic fracture noted on anteroposterior (AP) pelvic radiographs were prospectively evaluated over a 21-month period. AP, inlet, and outlet radiographs as well as CT scans were obtained on all patients. SETTING: Level I trauma center. PATIENTS: Patients were excluded who had a Glasgow Coma Scale score less than or equal to 12, were unable to cooperate with a PE, were 12 years old or younger, or had concomitant acetabular fracture. INTERVENTION: A focused PE protocol with emphasis on the posterior pelvis, including posterior palpation of the sacrum and sacroiliac joint, AP and lateral iliac wing compression, active hip range of motion, and a digital rectal examination. If an individual PE parameter resulted in tenderness, it was considered positive. MAIN OUTCOME MEASUREMENTS: The 4 PE modalities were compared with CT scan results using sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratio, and McNemar's test for discordant pairs. RESULTS: The study group included 66 patients. Of patients, 49 (74%) had posterior pelvic injury diagnosed by CT scan. Of the patients with positive posterior CT scan findings, 48 (98%) had pain with posterior palpation. Sensitivity and specificity were 0.98 and 0.94, and the likelihood ratio was 16.3. CONCLUSIONS: PE, specifically palpation of the posterior pelvis, in patients with pelvic fractures can accurately detect injuries of the posterior ring.     

Application of the Isler and Ganz classification of pelvic ring fractures in clinical practice]

The classification of pelvic fractures proposed by Isler and Ganz was applied to 152 patients. On the basis of this experience, the following conclusion were drawn. 1. It is possible to classify all pelvic ring injuries by dividing them in lesions of the anterior and of the posterior ring segment. 2. The classification requires a thorough examination; often a CT scan is needed. The original classification of 9 out of 18 patients based on X-ray morphology had to be revised after CT examination. 3. Once the pelvic injury is definitely classified the mode of therapy is determined as well.     

MRI脂肪抑制成像在老年骨质疏松性椎体骨折PKP治疗中的应用价值

目的评价MRI脂肪抑制成像在老年骨质疏松性椎体骨折椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗中的应用价值。方法自2008—02—2013—08对88例老年骨质疏松性椎体骨折行PKP治疗,根据入院前X线片及CT检查,分为单椎体组（56例）和多椎体组（32例）。术前行MRI脂肪抑制成像检查确定骨折椎体,比较2组行MRI检查前后的诊断符合率。结果单椎体组和多椎体组诊断符合率分别为83．9％和68．8％,差异有统计学意义（P〈0．05）。结论传统的X线片及CT检查对于骨质疏松性多发椎体骨折容易漏诊,MRI脂肪抑制成像能够提高骨质疏松性椎体骨折的诊断率。