骨盆骨折合并盆腔脏器损伤的影像学诊断

目的 探讨逆行尿路造影及CT检查在骨盆骨折合并盆腔脏器损伤诊断中的价值。方法 98例骨盆骨折的患者,对其中58例怀疑合并有尿道或膀胱损伤患者进行了逆行尿道造影,其中5例做了造影后螺旋CT检查;对所有患者进行定期随访。结果 58例术前作逆行尿道造影显示:后尿道断裂19例,膀胱破裂39例。5例注入对比剂后行螺旋CT扫描均显示膀胱破裂及对比剂的分布情况。34例尿道断裂术后随访显示:12例后尿道有不同程度狭窄,1例后尿道仍存在断裂、错位,1例后尿道狭窄并憩室形成,20例尿道通畅。64例膀胱破裂术后行逆行造影检查,未见对比剂外漏。结论 逆行尿道造影是术前明确诊断尿道或膀胱损伤的可靠方法,且为术后评价尿路通畅程度提供信息;注入对比剂后行CT扫描能好的显示膀胱破裂程度以及对比剂在盆腔的分布情况。

Imaging diagnosis of pelvic fracture and pelvis multiple organ injuries

Objective To evaluate the value of the retrograde urography and CT scan in the diagnosis of pelvic fracture and pelvis multiple organ injuries. Methods Ninety-eight patients who had pelvic fracture. Fifty-eight cases which suspected urethral or bladder injury were carried out retrograde urography pre-operatively. Then 5 cases were carried out spiral CT scanning. The patients followed up regularly. Results Among 58 cases of pre-operative retrograde urography, 19 cases were posterior urethral disruption, 39 cases were bladder rupture. The 5 cases which carried out spiral CT scanning display bladder rupture and contrast medium geographical distribution in pelvis. Follow up of 34 cases post-operative demonstrated 12 cases had varying degrees of urethral stricture, 1 case had posterior urethra rupture and dislocation, 1 case had urethral stricture and diverticularization, 20 cases were unobstructed. Follow up of 64 cases of bladder rupture, there were not leakage of contrast agent. Conclusion The retrograde urography is a reliable method for urethral or bladder injury preoperatively. It also provides information for evaluation unobstructed degree of urinary tract postoperatively. After injected contrast medium, CT scan can display bladder rupture and contrast medium geographical distribution in pelvis.