胸骨骨折的多层螺旋CT诊断

目的:探讨胸骨骨折的MSCT轴面和多平面重组(MPR)表现及其诊断价值,并对比分析胸骨骨折与胸部创伤程度的相关性。方法:收集车祸伤所致胸部创伤合并胸骨骨折31例为研究组,胸部创伤未合并胸骨骨折30例为对照组,均行16层螺旋CT胸部扫描,观察研究组在轴位图像及MPR图像上胸骨骨折发生的解剖部位、数量、类型及断端移位情况,并比较两组中合并胸部其他创伤的出现率。结果:常规轴位CT扫描对胸骨横行骨折及未发生分离移位骨折的检出率低于MPR(P<0.05)。研究组创伤性湿肺、多发性肋骨骨折及胸腔积液的发生率明显高于对照组(P<0.05)。31例中18例出现明显分离移位,常规轴位图检出胸骨骨折26例(81.25%),包括移位骨折中的18例(100%)和非移位骨折中的8例(61.54%),其中非移位骨折检出率低于MPR(P<0.05),总体检出率则无显著性差异(P>0.05)。结论:胸骨骨折有明显移位时在常规横断面上即可诊断,但无明显移位时需要结合MPR诊断;胸骨骨折的出现意味着创伤性湿肺、多发性肋骨骨折以及胸腔积液发生率高,病情重。

MSCT Diagnosis of Sternal Fracture

Purpose:To investigate the value of MSCT in diagnosis of sternal fracture.Methods: Thirty-one consecutive traffic accident patients with clinically confirmed sternal fracture were served as a test group.Thirty consecutive traffic accident patients with normal sternum at the same time were served as a control group.All patients underwent conventional thoracic scan with 16-section MSCT,and all the CT data were subsequently used to perform multiplanar reformation(MPR) to illustrate the fractures in detail.The numbers,anatomic sites and status of the fractures were determined on both conventional traverse CT images and MPR images.And the differences in the types of thoracic trauma involving the lung,thoracic cavity,ribs or thoracic vertebra were compared statistically between the test and control group.Results: The detection rate of sternal with traverse or stable fracture by conventional traverse CT were lower than that by MRP(P<0.05).The occurrence rates of traumatic wet lung,fractures of multiple ribs and pleural effusion were much higher in test group than that in control group(P<0.05).Unstable fracture was occurred in 18cases.By conventional traverse CT,the fracture could be detected in 26 patients(81.25%),including 18 unstable fractures(100%)and 8 stable fractures(61.54%).The detection rate of stable fracture by conventional CT were lower than that by MPR,however,there was no difference in the overall detection rate between traverse CT image and MPR image(P>0.05).Conclusion: Sternal fracture with obviously displacement can be detected by conventional traverse CT image;however,MPR can be helpful in illustrating stable sternal fracture.The occurrence of sternal fracture may indicate high incidences of traumatic wet lung,fracture of multiple ribs and pleural effusion,and is often associated with bad condition.