眼球损伤的CT诊断

目的 :探讨眼球损伤 CT诊断的价值。方法 :回顾 48例 CT及眼科证实的眼球损伤患者。 CT检查常规 3mm横断扫描 ,14例加作冠状扫描 ,31例加作冠状和 /或矢状重建。手术 45例。结果 :48例中 ,球内金属异物 19只占 40 % ,球后金属异物 9只占 19% ;眼环一处或多处断裂 38只占 78% ;晶状体脱位 3只占 6 % ,晶状体膨大、密度减低 5只占 10 % ;晶状体脱落 5只占 10 % ,眼球增大 3只占 6 % ,眼球缩小 9只占 19% ,眼环增厚 16只占 33% ;前房变浅 2只占 4% ,前房加深 8只占 17% ;玻璃体内出血 9只占19% ;视网膜下积血 2只占 4%。结论 :CT扫描能明确眼球损伤的范围 ,准确诊断损伤的程度 ,因而是诊断眼球损伤的重要方法之一     

CT对外伤性晶状体损伤的诊断价值

目的：探讨外伤造成晶状体损伤的CT表现,并对其进行分析.方法：对42只临床证实有晶状体损伤的伤眼,对照CT检查结果,观察晶状体的位置、形态、密度改变.结果：CT诊断外伤性白内障18只（42.8%）,晶状体全脱位10只（23.8%）,半脱位6只（14.2%）,未见异常改变10 只（23.8%）.CT诊断与临床诊断符合率76.1%.结论：CT检查对晶状体损伤的诊断有重要价值.     

眼眶外壁骨折的CT分析

目的：探讨眼眶外壁骨折的临床特点并评价ＣＴ检查对其诊断价值。方法：以１５５例眼眶外壁骨折为研究对象,均行眼眶横断及冠状位ＨＲＣＴ检查。结果：眶外壁骨折受伤原因以车祸最多,失明者达５６．７７％,还可表现为眼球运动受限、眼球内陷等。眼眶外壁分为四段,以前三段骨折多见,且多波及颧骨蝶骨缝,造成骨缝分离移位;后段骨折少见,但失明发生率却明显高于其它各段（Ｐ＜０．０１）。单纯眶外壁骨折少见,仅占２１．２９％;外壁骨折伴发邻近骨折占７８．７１％,多伴发其它眶壁骨折。结论：ＨＲＣＴ检查是诊断眶外壁骨折较好的方法,眼部创伤后应及时行ＣＴ检查。     

浅析轻型颅脑外伤临床与CT扫描的相关性

目的 :研究轻型颅脑外伤的临床及CT表现,总结与轻型颅脑外伤密切相关的高危因素,探讨CT检查的适应证。方法:采用前瞻性队列研究,对180例受伤24 h以内的轻型颅脑外伤患者进行注册登记,根据CT结果分析,探讨轻型颅脑外伤的CT检查适应征。结果 :能准确评估颅脑损伤程度的有:神经查体阳性、格拉斯哥昏迷评分(GCS)15分及年龄≥60岁者、可疑颅骨骨折及锁骨上损伤体征阳性,可作为轻型颅脑外伤患者CT检查适应证。不具备上述5项临床表现中任意1项者,CT检查阴性率为100%,可暂不行CT检查。结论:通过此项研究,为临床医师诊疗轻型颅脑外伤患者提供更加合理化的指导意见,有助于临床医师对颅脑损伤做出准确评估,有效避免不必要的CT检查。     

闭合性腹部外伤致胰腺损伤的CT诊断(附15例报告)

目的:评价CT对闭合性腹部外伤所致胰腺损伤的临床诊断价值。方法:回顾性分析15例经手术证实的闭合性腹部外伤所致胰腺损伤的CT征象。结果:15例闭合性腹部外伤所致胰腺损伤中,胰腺挫伤5例,胰腺完全性断裂6例,胰腺不完全性断裂1例,胰腺出血3例。胰腺内出血、水肿,胰腺增粗是胰腺挫伤的直接征象;胰腺外形不连续、平扫或增强时垂直胰腺长轴的低密度、线条状影是胰腺断裂的直接征象。胰周积液、网膜囊积血积液,肾前筋膜增厚,腹腔积液是胰腺损伤的间接征象。结论:CT检查对胰腺损伤的诊断价值较大,CT增强比平扫更能明确胰腺的断裂;CT检查对于主胰管的断裂的诊断价值有待进一步研究。     

眼球破裂的CT分型与临床意义

目的回顾性分析４９只眼球破裂伤，讨论眼球破裂伤的ＣＴ表现、ＣＴ分型及其临床意义，进一步提高正确诊断率，指导临床治疗。材料与方法４９只证实的眼球破裂伤，７９％的患者在１天内行ＣＴ检查。常规轴位扫描，层厚３ｍｍ，层间距３ｍｍ，矩阵２５６×２５６；用骨窗和软组织窗条件分析眼眶骨质和眼球结构。结果眼环一处断裂占３２％，二处断裂占２０％，多处断裂占２８％。眼环增厚至５ｍｍ的１０只、６ｍｍ的２４只、７ｍｍ的９只；２０％眼球增大，３２％眼球缩小；１４只眼前房加深＞４ｍｍ；８３％合并球内出血，４８％球内存有异物；２８％患眼突出，７５％合并副鼻窦、眼眶骨折或脑挫裂伤；据ＣＴ表现结合临床处理将眼球破裂分为三型，重度破裂已无法修复，无复明希望，应行眼球摘除术，而轻、中度破裂均可行清创修复。结论ＣＴ检查是确定有无眼球破裂和估价破裂程度的最好方法之一，并可为临床处理提供重要依据。     

Crouzon综合征颅面部的CT表现(附8例报告)

目的 总结Crouzon综合征颅面部的CT表现,提高对该病的认识.资料与方法 回顾性总结分析8例Crouzon综合征颅面部CT征象.结果 CT均表现为眼眶、鼻腔鼻窦、颞骨、颌骨及颅底的异常.眼眶:眶腔变浅,眶外壁夹角增大,眶距增宽以及眼球突出16眼,视神经迂曲7眼,眼外肌增粗10眼;鼻腔鼻窦:鼻腔狭窄伴鼻中隔偏曲8例,鼻窦发育差6例,鼻咽腔变窄7例;颞骨:壶腹型内耳道8例,乳突气化差4例,乳突炎4例;颌骨:上颌骨发育不良,硬腭高拱,口腔顶壁呈倒"V"字形6例;颅底:颅骨内板弥漫性深大脑回压迹,蝶骨大翼狭长菲薄,颞窝变小,前颅窝底低位,颈静脉球窝增大8例,蝶鞍异常5例,乙状窦前位4例.结论 CT能够为Crouzon综合征颌面部的异常改变及其并发症的评估提供客观依据.     

多层螺旋CT多平面平行范围重建技术在眼部外伤中的临床应用

目的探讨多层螺旋CT多平面平行范围重建在诊断眼外伤中的应用价值。方法对40例眼外伤患者行多层螺旋CT常规检查,层厚2mm,准直器0.75mm,并行多平面重建(MPR)及任意角度的平行范围重建(PRR),并对CT征象进行分析。结果对眼部阳性异物做出准确定位并经临床证实者14例,其中6例常规CT扫描定位有误;眼眶壁骨折者21例,其中9例常规CT扫描未发现或有部分漏诊;眼直肌损伤者16例,6例经MPR PRR重建后明确诊断;眼球损伤者16例,其中4例常规CT扫描诊断难以明确,经重建后确诊;视神经损伤5例,其中4例常规CT扫描未发现。结论多平面平行范围重建在眼部外伤的综合诊断中具有重要价值。     

膝关节半月板损伤的CT诊断

本文报告经ＣＴ检查诊断的膝关节半月板损伤 82例 ,以期提高对半月板损伤ＣＴ诊断的认识。1　材料与方法　　 82例中 ,男 65例 ,女 1 7例 ,年龄 1 4～ 59岁 ,平均年龄32 3岁。多以膝关节外伤后临床怀疑半月板损伤而就诊 ,病程 2天～ 1 2年不等。应用ＳｏｍａｔｏｍＣＲＣＴ扫描机 ,采用平扫或充气造影加ＣＴ扫描 (于髌上囊穿刺后注入空气 1 0 .0～ 50 .0ｍｌ,然后用绷带包紧髌上囊 ,将气体压入膝关节腔 ,使患者活动后行ＣＴ扫描 )。扫描体位 :双脚跟并拢 ,脚尖自然分开约 60°,双侧膝关节屈曲 1 5°并拢 ,可用加压带固定。2　结果　　本组 …     

53例颅脑创伤患者耳部损伤的临床表现与多层螺旋CT发现的相关性研究

目的探讨颅脑创伤病人耳部损伤的临床表现与多层螺旋CT发现的相关性。方法对53例颅脑创伤疑有耳部和面神经管损伤的患者进行了耳部CT扫描和3D图像重组,统计、分析各型颞骨骨折CT所见与临床症状、体征的相关性。结果本组53例颞骨骨折,其中纵行骨折34例(64.2%),混合性骨折14例(26.4%),横行骨折5例(9.4%);内耳完整型48例(90.6%),内耳受损型5例(9.4%)。脑挫裂伤或(和)脑内血肿21例:其中单侧颞叶损伤11例、双侧5例,弥漫性轴索损伤1例,脑干损伤1例;硬膜外或(和)硬膜下血肿8例,蛛网膜下腔积血6例。结论多层螺旋CT(MSCT)3D成像技术立体、直观、真实地再现了耳部及面神经管细微、复杂的影像学解剖和病理改变,可为临床早期诊断,及时选择合理、恰当的治疗方案以及预后评估等提供较好的影像学依据。     

CT of orbital trauma

In a patient with acute orbital trauma, visual acuity and extraocular muscle motility are the two most important ophthalmologic functions to be evaluated emergently. The assessment of these capabilities may sometimes be difficult due to the severity of the head injury, the extent of periorbital soft tissue edema, inadequate cooperation in alert patients, and a reduced level of consciousness in obtunded individuals. Consequently, computed tomography (CT) has come to play a major role in the orbital examination of acute trauma patients. In this study, in conjunction with clinical evaluation, we have sought to utilize CT to determine the various prevalences of the causes of decreased visual acuity and extraocular muscle motility resulting from orbital trauma. We retrospectively reviewed the records of all patients admitted to our emergency facility who, having suffered head trauma, underwent a CT study for diagnosis. CT examinations of the head using a multidetector scanner were performed from the base of the skull to the vertex at 5-mm intervals. Orbital CT was obtained when a routine CT of the head showed periorbital soft tissue edema and/or facial bone fractures. The orbital CT examination was performed using axial 1-mm and coronal 3-mm slices. Coronal reformation images were prepared if the patient was unable to tolerate the prone position for direct coronal imaging. The imaging findings were correlated with ophthalmologic observations. The orbit floor was the most common and the orbital roof the least common site of fracture of the bony coverings of the eye. Twenty-three patients suffered decreased visual acuity. In order of declining frequency, the causes of reduced vision consequent to trauma were retrobulbar hemorrhage, optic nerve thickening presumably secondary to edema, intraorbital emphysema, optic nerve impingement, detached retina and ruptured globe. Five patients had visual impairment without demonstratable radiographic abnormalities. The most common finding associated with diminished extraocular muscle motility was muscle impingement by fracture fragments, followed in decreasing frequency by thickened muscle due to edema or contusion, intraconal emphysema, muscle entrapment, and retrobulbar fat herniation. Six patients with decreased extraocular muscle activity had no abnormalities demonstrated on CT images. The overwhelming majority of patients with decreased visual acuity or reduced extraocular muscle motility consequent to trauma had abnormalities demonstrated by orbital CT. Hence, CT examinations should play a major role in the evaluation of the intraorbital contents in patients with orbital trauma.     

209例肝脏损伤的流行病学特征及临床分析

目的：总结创伤性肝破裂的流行病学特征并探讨其临床特点及救治效果。方法：总结分析我科1988－1999年收治209例肝破裂病例的临床资料。本组Ⅲ级以上严重肝脏损伤108例（51．7％），手术治疗186，保守治疗23例。结果：手术治疗组186例，治愈169例，18例发生并发症，其中死17例。保守治疗组23例中死亡1例。结论：严重的伤情和治疗的延误是导致本组肝外伤死亡的两大主要因素。外科手术仍是治疗创伤性肝破裂的主要措施；保守治疗应严重掌握适应证。     

严重多发伤损伤特点及其救治

目的：探讨严重多发伤的损伤特点及诊治方法。方法：回顾性分析我院1980年1月-2002年6月救治的1216例严重多发伤病例资料。伴休克者液体复苏以平衡盐液为主，适量输血及补充胶体液，214例伴严重失血性休克者早期复苏阶段补液量达10 000-15000ml/24h以上。手术治疗1185例，1054例行ICU监护及治疗。结果：伤后确诊时间平均4.7小时，早期漏诊率7.6％。损伤脏器依次为：四肢、腹、胸、头等。休克发生率达84.9％，发生脓毒症132例（10.9％），急性肺损伤及ARDS387例（31.8％），MODS125例（10.3％），应激性溃疡137例（11.3％）。1107例（91.04％）治愈，109例（8.96％）死亡。结论：及时控制出血，减轻缺血缺氧损害；正确掌握手术时机、及时准确地手术；维护重要脏器功能，减少内脏并发症是严重多发伤救治的关键环节。     

腹部钝性创伤中肠道及肠系膜损伤的CT表现

肠道及肠系膜损伤在腹部钝性伤中的发生率较高且易出现诊断延迟或漏诊。多层X线计算机断层成像具有较高的空间、时间和对比度分辨率,提高了肠道及肠系膜损伤诊断率。可显示腹腔内脏器损伤的直接和间接影像,指导非手术治疗或手术治疗的选择和效果评估。本文就肠道及肠系膜损伤在CT中特异性和非特异性征象作一论述。     

CT assessment of orbital volume in late post-traumatic enophthalmos

The potential of CT to facilitate preoperative planning of reconstructive maxillofacial surgery by orbital volume quantification was analysed in 11 patients with traumatic enophthalmos as a late sequela of zygomatic fractures. We carried out biplanar CT examination of the orbits, and calculated total orbital and fat volumes for the healthy and enophthalmic sides. Displacement of the orbital floor and lateral wall was present in 11 and 7 cases respectively. Indentation of the medial wall was noted in 9 cases. Quantitative evaluation of the orbital cavity revealed a significant increase (P<0.0188) in total volume on the enophthalmic side, the difference between the two sides ranging from 9.2% to 36.4%, mean 17.9%. The degree of enophthalmos, measured radiologically as 2.5–5 mm, correlated with the increase in orbital cavity volume (P=0.000076). Enophthalmos was 2.5–3 mm in 7 cases (63.6%) and 3.5–5 mm in 4 (36.4%). This corresponded with a mean increase in orbital volume of 3.4 ml (12.3%) and 7.1 ml (27.8%) respectively. Fat atrophy was not an aetiological factor in the production of post-traumatic enophthalmos.     

眼眶骨折的CT表现及分型(附86例分析)

目的探讨CT对眼眶骨折的诊断价值及分型方法。方法回顾性分析86例共92只眼眶骨折的CT特征，根据眼眶骨折的部位、范围及其他部位受累的情况，将眼眶骨折分为单纯型、复杂型、复合型。结果在92只眼眶骨折中，单纯型57只（61．97％），复杂型10只（10．87％），复合型25只（27．17％）。结论cT检查可较全面地观察眼眶骨折的情况，为临床治疗提供重要依据，是眼眶骨折的首选检查方法。     

肾创伤的诊断及外科治疗(附148例报告)

目的 探讨肾损伤的诊断和治疗方法。方法 从1987年3月－2000年12月共收治肾损伤148例，其中闭合性损伤132例，开放性损伤16例。合并 其它脏器损伤34例。结果 148例中有肉眼血尿者98例，镜下血尿者42例，无血尿者8例。行静脉肾盂造影检查（IVP）32例，有异常者20例（62．5％）。行CT扫描检查52例，其中44例均有异常改变（84．62％）。109例行保守治疗，39例行手术探查，有28例行肾切除术，8例行肾修补或部分肾切除术，3例行单纯肾周引流术。本组死于多器官损伤3例，休克后出现弥漫性血管内凝血（DIC）1例。137例痊愈出院（92．57％）。结论 在肾损伤诊断中尿常规和B超检查具有简单、快速、无损伤等优点。CT扫描检查准确率高，可判断肾损伤程度和其它脏器合并伤情况。对严重肾损伤和开放性肾损伤应及时手术探查。     

Isolated severe renal injuries after minimal blunt trauma to the upper abdomen and flank: CT findings

Renal injuries caused by blunt abdominal trauma are common in children. Serious renal trauma is associated with insult to other organs, whereas isolated renal injuries are usually minor. We present the cases of six male children (aged 7–17 years) with major isolated renal injuries due to minimal blunt trauma to the upper adbomen and/or the flank, out of a total of 21 children admitted with renal trauma in a 5-years period. On physical examination all patients had a painful, tender abdomen and/or flank with ipsilateral bruises and ecchymosis. Hematuria, either macro (n=4) or micro (n=2), was found in all. The injuries were left-sided in five and were of a variable severity (grade III: n=2; grade IV: n=3; grade V: n=1 according to the kidney injury scale of the American Association for the Surgery of Trauma). Four children underwent nephrectomy. This small series underlines that major kidney insult can occur after a minimal blunt trauma localized to the flank or upper abdomen. Abdominal CT should be performed when clinical or laboratory findings or the mechanism of trauma suggest renal injury.     

CT对腹部钝伤的诊断价值与限度

目的：探讨CT对腹部钝伤的诊断价值与限度。方法：应用CT扫描对42例胳部钝伤患者进行了检查。结果：CT扫描发现肾外伤19例,肝外伤5例,脾外伤19例,肠系膜血肿2例,肠穿孔2例,其中有5例为复合伤。CT扫描能清楚地显示脏器损伤及胳腔出血的程度和范围。结论：CT能迅速、准确地检出腹腔脏器损伤,为临床选择治疗方法提供重要依据。     

CT在颈椎损伤中的诊断价值

目的：探讨CT扫描在颈椎损伤中的诊断价值。方法：回顾性分析32例颈椎损伤的CT与平片检查资料。结果：骨折28例（其中6例伴脱位）,单纯脱位4例,合并伤10例。结论：CT对颈椎损伤的检出率明显高于平片,能清晰显示其损伤的细节,并对判断失稳及椎管狭窄的程度均有重要价值。