汶川大地震颌面部损伤CT诊断价值

目的 探讨汶川大地震伤员颌面损伤CT表现及其诊断价值.方法 对2008年5月12日-7月23日就诊的汶川大地震颌面部伤员51例的CT资料进行回顾性研究.结果 颌面部骨折21例,多发骨折12例.眼部外伤性改变9例,鼻面部外伤性改变38例.结论 地震颌面部损伤发生部位主要在鼻面部.CT扫描结合临床检查,能对地震性颌面部外伤...     

汶川大地震胸部损伤影像学表现及其诊断价值

目的：分析四川汶川大地震胸部损伤患者影像学表现及其价值。方法：对地震发生后近2个月余陆续送至四川大学华西医院治疗,因地震致有胸部损伤史的155名伤员进行影像学分析总结。结果：在本组伤员中,胸廓骨折139例,胸膜损伤160例,肺损伤55例,纵隔损伤28例,肺部慢性感染39例,肺部肿块2例。其中部分伤员为多处复合性损伤。结论：影像学检查能准确、快速、有效地对地震胸部损伤患者进行判断,可为临床治疗方案起指导作用。     

汶川大地震伤员脊柱损伤X线表现

目的:研究本次地震中椎体损伤所占比例及椎体损伤类型。方法:分析我院2008年5月12日至2008年5月31日采用DR、CR投照和/或16排螺旋CT检查地震伤员1767人次的影像学资料。采用DR、CR投照及16排螺旋CT检查,其中平片检查1317例,CT扫描450例。结果:291例伤员椎体损伤(16.5%),其中单纯椎体损伤237例(13.4%),椎体损伤合并其他部位损伤54例(3.1%)。结论:脊柱损伤在地震伤中占较大比例,在救治及搬运伤员的过程中需要注意保持脊柱的稳定性。     

汶川地震脊柱损伤CT诊断及其价值

目的：分析四川汶川地震脊柱损伤患者CT表现及其价值。方法：对地震发生后近2个月内先后送至四川大学华西医院治疗的148名脊柱外伤伤员,进行脊柱骨折特点CT分析。结果：148例伤员共有341个椎骨骨折,其中颈椎骨折49个,胸椎骨折110个,腰椎骨折179个,骶椎骨折3个。压缩骨折43个,爆裂骨折41个,后柱断裂149个,压缩骨折合并后柱断裂6个,爆裂骨折合并后柱断裂102个,骨折脱位18个。148例脊柱伤员有84例伴发椎管狭窄。结论：CT能准确、快速地对地震脊柱损伤患者进行诊断,为临床治疗起到指导作用。     

5·12汶川大地震脊椎外伤影像表现分析

目的：探讨5.12汶川大地震致脊椎外伤伤员的影像学表现特点。方法：回顾性分析自2008年5月12日至6月12日因地震性脊柱外伤在我院行放射检查者,共320例。其中行X线检查310例,CT检查38例,MRI检查15例。结果：148例伤员影像学检查为阳性,阳性率为46.25%。30-39岁年龄组伤员人数最多,为68例,其中女性40例。阳性伤员中,多发伤有80例（54.05%）。单一椎体骨折98例,多发椎体骨折42例,椎体脱位12例。椎体压缩骨折114个,爆裂骨折26个,附件骨折31个。310例伤员中,共累及182个椎体,即颈椎15个,胸椎59个,腰椎100个,骶椎8个。结论：地震致脊椎外伤受累人群主要为30-39岁青年女性,多发伤多见。单一椎体骨折相对多见,骨折损伤类型以压缩性骨折为主,腰椎为最常见受伤部位。影像学检查有助于脊柱外伤的及时准确诊断。     

汶川地震腹部损伤CT诊断价值

目的：探讨四川汶川地震腹部损伤伤员CT表现及其诊断价值。方法：对我院因汶川地震受伤,需做腹部CT的伤员27例的治疗,进行CT分析。结果：在本组腹部损伤伤员中,肝脏病变7例,胆囊病变2例,胰腺病变11例,脾脏病变8例,肾脏病变11例,腹腔积液6例,腹腔积气9例,胃肠道病变8例,子宫病变1例。部分伤员为两个或两个以上器官受累。结论：CT检查结合临床治疗能快速、准确、有效的对地震腹部损伤伤员进行判断,对临床诊治具有重要作用。     

汶川大地震颅脑损伤的临床特点及救治策略

目的：分析汶川大地震颅脑损伤的临床特点,探讨救治策略。方法：对2008年5月12日至6月2日汶川大地震中什邡市二医院收治的222例颅脑损伤伤员进行总结分析。结果：大批地震伤员中,颅脑损伤主要以轻、中型颅脑损伤为主,其中以头皮裂伤最多见,其次为脑挫伤、硬膜下血肿、硬膜外血肿、开放性脑损伤。大部分颅脑损伤伤员合并有其他部位损伤,以合并四肢骨折最多见。开展手术28例,死亡7例。结论：地震后伤员在短期内集中大量达到,颅脑损伤以头皮裂伤多见,医院有效的组织,快速评估病情,制定有效的治疗计划,注意合并伤的处理,强化院前急救以及三线医院转送,提高救治成功率。     

213例汶川大地震伤员放射学检查分析

目的分析汶川大地震伤员的放射学表现特点。方法收集2008年5.12汶川大地震发生后至5月31日间213例地震伤员的完整放射学资料,着重分析伤员的X线、CT、MRI检查的影像学表现特点。结果 213例中,同时行X线、CT、MRI检查10例（5%）,X线、MRI检查7例（3%）,X线、CT检查9例（4%）,仅行CT检查5例（2%）,仅行X线检查182例（85%）。MRI检查17例（8%）中,同时行胸椎和腰椎检查2例、颈椎和胸椎1例,颈椎1例,膝关节2例,上腹部1例,骨盆1例,腰椎9例;CT检查24例（11%）中,头部9例,胸部6例,腹部1例,脊柱6例,骨盆2例;X线检查208例中,单部位检查64例（31%）,多部位检查144例（69%）,仅有软组织受伤38例（18%）,单纯肺挫伤6例（3%）,骨折164例（79%）。结论地震伤员影像学检查以常规X线为主,头颅、五官受伤者首选CT,CT、MRI检查作为胸部、脊柱、关节等部位的补充检查。地震伤员以单纯性骨折为主,骨折合并脏器外伤较少。     

汶川大地震骨盆骨折放射学表现分析

目的：分析汶川大地震中伤员骨盆骨折的发生部位及骨折类型。方法：对地震发生后近2个月内先后送至四川大学华西医院治疗的95例骨盆骨折伤员,按放射学检查结果进行骨折部位及类型分析。结果：95例伤员共发生133个部位的骨折。按骨折部位分类：髂骨22个（16.6%）,坐骨10个（7.5%）,耻骨81个（60.9%）,髋臼18个（13.5%）,骶尾骨2个（1.5%）。按骨折类型分类：斜行骨折71个（53.4%）,粉碎性骨折43个（32.3%）,线性骨折11个（8.3%）,横行骨折5个（3.7%）,嵌插骨折3个（2.3%）。结论：地震造成骨盆骨折部位以耻骨为主,类型以斜行骨折为主。对骨盆骨折伤员,X线及CT检查相结合能为临床提供更好的影像诊断价值。     

汶川地震颅脑损伤CT诊断及其价值

目的：分析四川汶川地震颅脑损伤患者CT表现及其价值。方法：对地震发生后近2个月内陆续送至四川大学华西医院治疗,因地震致有颅脑损伤史的140名伤员进行颅脑CT分析总结。结果：在本组伤员中,头皮损伤97例（69％）;颅骨骨折68例（49％）;脑挫裂伤66例（47％）;硬膜外和（或）硬膜下积血、积液44例（31％）;蛛网膜下腔出血36例（26％）;脑水肿、软化灶29例（21％）;其他43例（31％）。结论：CT扫描能准确、快速、有效地对地震颅脑损伤患者进行判断,可为临床治疗方案起指导作用。     

Multidetector CT findings of skeletal chest injuries secondary to cardiopulmonary resuscitation

Introduction

Rib and sternal fractures are frequent complications of cardiopulmonary resuscitation (CPR) in adults. This is the first study to evaluate the MDCT findings of chest injuries secondary to CPR, by comparing with the findings of radiography.

Methods

For 40 patients who underwent MDCT after CPR for a non-traumatic cause of cardiac arrest, we evaluated the MDCT findings of the CPR associated traumatic chest injuries and compared the diagnostic performance of chest radiography and MDCT for the evaluation of chest injuries.

Results

MDCT revealed that 26 patients (65%) had rib fractures and 12 patients (30%) had sternal fractures. However, radiography detected only 10 patients who had rib fractures. In 25 of the 26 cases, multiple ribs were fractured (ranging up to 13 rib fractures), and the rib fractures were bilateral in 18 of these cases. The majority of rib fractures were located in the anterior part of the thoracic cage. Six of the patients had fracture-related complications (pneumothorax = 1, subclavian vein injury = 1, chest wall hematoma = 4). The sternal fractures predominantly occurred in the middle and lower third of the sternal body (five each for the middle and lower third of the sternal body).

Conclusion

Rib and sternal fractures are frequent complications in patients who underwent CPR. MDCT is useful for the evaluation of chest injuries secondary to CPR as compared with that of radiography and also for the evaluation of the fracture-related complications.     

Imaging of acute thoracic injury: the advent of MDCT screening.

Chest radiography remains the primary screening study for the assessment of victims of chest trauma, but computed tomography (CT), particularly multidetector CT (MDCT), has progressively changed the imaging approach to these patients. MDCT acquires thinner sections with greater speed, allowing higher quality axial images and nonaxial reformations than conventional or single-detector helical CT. The speed of MDCT, both in acquiring data and in reconstructing images, makes the performance of total body surveys in the blunt polytrauma patient practicable. In general, CT has been well documented to offer major advantages over chest radiography in both screening for thoracic injuries and in characterizing such injuries. This capacity has been enhanced by the application of multichannel data acquisition. The greater sensitivity of MDCT has been well demonstrated in diagnosing vascular and diaphragmatic injuries. This article reviews current concepts of diagnostic imaging in acute chest trauma from blunt force and penetrating mechanisms emphasizing the spectrum of diagnostic imaging findings for various injuries, based primarily on radiographic and CT appearances. The advantages of MDCT for selected injuries are emphasized.     

Multi-detector row CT imaging of blunt abdominal trauma.

CT is the imaging modality of choice to evaluate hemodynamically stable patients suffering blunt abdominal trauma. During the past five years, single-slice helical CT has been replaced by multidetector row CT (MDCT). This development has revolutionized cross-sectional imaging for blunt trauma patients. Volumetric imaging with helical CT has been a major factor supporting the nonoperative management of solid organ injury. Trauma centers in the United States are replacing single-slice helical CT scanners with state-of-the-art MDCT in suites proximate to the patient receiving area and with facilities for monitoring and maintaining physiologic support. The ability to obtain high-resolution images with MDCT during optimal contrast enhancement at unparalleled speed helps detect the presence and define the extent of injuries, and crucially, to diagnose hemorrhage and vascular injuries. This article describes our current imaging protocol with MDCT-16 (i.e., 16 detector MDCT), the spectrum of diagnostic findings seen in blunt abdominal injury, and the role of MDCT in the characterization of hemorrhage and planning injury management.     

Screening performance of the chest X-ray in adult blunt trauma evaluation: Is it effective and what does it miss?

BackgroundAlthough chest x-ray (CXR) is often used as a screening tool for thoracic injury in adult blunt trauma assessment, its screening performance is unclear. Using chest CT as the referent standard, we sought to determine the screening performance of CXR for injury.MethodsWe analyzed data from the NEXUS Chest CT study, in which we prospectively enrolled blunt trauma patients older than 14 years who received chest imaging as part of their evaluation at nine level I trauma centers. For this analysis, we included patients who had both CXR and chest CT. We used CT as the referent standard and categorized injuries as clinically major or minor according to an a priori expert panel classification.ResultsOf 11,477 patients enrolled, 4501 had both CXR and chest CT; 1496 (33.2%) were found to have injury, of which 256 (17%) were classified as major injury. CXR missed injuries in 818 patients (54.7%), of which 63 (7.7%) were classified as major injuries. For injuries of major clinical significance, CXR had a sensitivity of 75.4% (95% confidence interval [CI] 69.6–80.4%), specificity of 86.2% (95% CI 85.1–87.2%), negative predictive value of 98.3 (95%CI 97.9–98.6%), and positive predictive value of 24.7 (95%CI 22.9–26.7%). For any injury CXR had a sensitivity of 45.3% (95% CI 42.8–47.9%), specificity of 96.6% (95% CI 95.9–97.2%), negative predictive value of 78% (95% CI 77.2–78.8%), and positive predictive value of 86.9% (95% CI 84.5–89.0%). The most common missed major injuries were pneumothorax (30/185; 16.2%), spinal fractures (19/39; 48.7%), and hemothorax (8/70; 11.4%). The most common missed minor injuries were rib fractures (381/836; 45.6%), pulmonary contusion (203/462; 43.9%), and sternal fractures (153/229; 66.8%).ConclusionsWhen used alone, without other trauma screening criteria, CXR has poor screening performance for blunt thoracic injury.     

多排螺旋CT鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌

目的 探讨多排螺旋CT(MDCT)鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌的价值。方法 回顾性分析经手术病理证实的11例黄色肉芽肿性胆囊炎(XGC)和20例胆囊癌(GBC)的资料,所有患者术前均接受MDCT检查,并分析两种病变的CT征象。结果 胆囊壁的增厚方式、黏膜线情况、是否有壁内低密度结节和胆道梗阻在XGC和GBC患者间差异有统计学意义(P均<0.05)。XGC与GBC患者发生邻近肝脏及周围组织改变的病例数差异无统计学意义(P>0.05),但邻近组织改变的形式不同。结论 MDCT扫描可为鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌提供客观依据。     

Multidetector-row computed tomography of thoracic trauma

Imaging in trauma patients has dramatically evolved since the advent of computed tomography (CT), particularly multidetector CT (MDCT) technology. Axial MDCT images of the body can be acquired in seconds and shown any plane, allowing immediate viewing and interpreting. These factors make CT an invaluable means to detect many injuries not previously visible by any other noninvasive imaging techniques. Potentially subtle, but significant, thoracic injuries such as pneumothorax, haemothorax, aortic injury, sternal and spinal fractures can be detected on MDCT easily. In this article, the author will discuss the use of MDCT in the diagnosis of various thoracic injuries.     

多层螺旋CT及其三维重组诊断地震压砸伤胸部骨折

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.     

MDCT诊断右心室双出口

目的 探讨MDCT诊断右心室双出口（DORV）的价值。方法 回顾性分析经手术或心血管造影确诊的36例DORV患者的临床及影像资料,将术前MDCT和超声心动图结果与手术结果进行对比。结果 MDCT明确诊断34例,误诊2例,诊断正确率为94.44%（34/36）,超声心动图诊断正确率为75.00%（27/36）,差异有统计学意义（P=0.022）。对判断室间隔缺损（VSD）与大动脉关系及大动脉位置关系,MDCT正确率均为100%（36/36）,超声心动图诊断准确率为80.56%（29/36）,差异有统计学意义（P=0.017）。共合并心内外畸形119处,MDCT与超声心动图对心内畸形检出率差异无统计学意义（P=0.474）;MDCT对心外畸形的检出率[98.72%（77/78）]高于超声心动图[69.23%（54/78）,P<0.001]。结论 MDCT可准确诊断DORV、准确检出合并畸形,对制定外科手术方案具有重要参考价值。     

208例芦山地震伤员康复需求分析

目的调查并分析芦山地震伤员的创伤类型、功能受限情况,以及伤员的康复需求。方法采用地震伤员康复需求调查表调查四川大学华西医院收治的208例芦山地震伤员的康复需求。结果208例被调查伤员的创伤类型以骨折居首（138例）,其次为复合伤、软组织损伤、肺挫伤和截肢。绝大部分伤员的运动功能、平衡功能、日常生活活动能力出现障碍,80％以上患者出现疼痛,少部分人出现感觉异常、呼吸障碍。大量患者需要康复辅具及住院治疗。结论芦山地震伤员的创伤类型及功能受限情况决定了患者所需康复辅具,结合伤员对康复的要求,可为伤员“量身定制”康复治疗方案。康复医学的早期介入极有益于地震伤员的康复。