多层螺旋 CT 联合后处理重建技术诊断创伤性胸骨骨折36例.docVIP

多层螺旋 CT 联合后处理重建技术诊断创伤性胸骨骨折36例 [摘要] 目的 探讨多层螺旋CT（MSCT）联合后处理重建技术在创伤性胸骨骨折中的应用价值。 方法 对36例胸骨骨折患者行常规胸部容积扫描后，利用工作站对胸骨进行多平面重建（MPR）和容积再现法（VR）重组，由两位有经验的放射科医师对后处理图像进行观察，并与胸部X线片进行比较。 结果 36例中，胸骨体骨折28例，胸骨柄骨折7例，剑突骨折1例。X线片诊断胸骨骨折24例，漏诊12例，检出率为66.7%；MSCT 联合MPR、VR后处理重建显示所有骨折，检出率100.0%，MSCT对胸骨骨折的检出率明显优于X线片（χ2 14.40，P 0.05）。 结论 MSCT容积扫描联合MPR、VR重建能高效、准确、全面显示胸骨骨折的部位、类型和伴发损伤，对胸骨骨折的诊断及治疗方案的制定具有重要的指导意义，可作为胸骨骨折的首选检查方法。 [关键词] 胸骨骨折； X线计算机；体层摄影术；胸部外伤 [中图分类号] R816.8 [文献标识码] B [文章编号] 1673-9701（2015）14-0109-04 [Abstract] Objective To evaluate the value of multi-slice CT（MSCT） and post-processing techniques in the diagnosis of sternal fractures. Methods MSCT volumetric scanning was performed in 36 patients with sternal fractures， multi-planar reconstruction（MPR） and volume rendering（VR） were reconstructed at workstation， CT findings of injured sternal were analyzed comparatively with that of radiography by two experienced radiologists. Results There were sternal body fracture in 28 cases， manubrium fracture in 7 cases and xyphoid process fracture in 1 case. 24 cases were diagnosed definitely and 12 cases were missed by radiography， the diagnosis rate of radiography was 66.7%， the diagnosis rate of MSCT technology combined with post-processing of MPR， VR images was 100.0%， there was significant difference in the diagnosis rate of MSCT technology than that of radiography （χ2 14.40， P 0.05）. Conclusion MSCT volumetric scanning combined with post-processing of MPR， VR images not only can show the location and type of sternal fractures but also can show other associated injuries， it has an important value in diagnosis and treatment of sternal fractures and should be the modality of choice for diagnosis of sternal fractures. [Key words] Sternal fractures； X-ray computed； Tomography； Chest trauma 钝性胸部外伤中胸骨骨折并不少见，由于胸骨特殊的解剖位置、结构和形态，胸部正侧位X线平片和常规轴位CT对胸骨骨折的诊断存在较大的局限性，易导致一些不明显的胸骨骨折漏诊，从而引发不必要的医疗纠纷。即使发现骨折，临床医生也难对骨折有一个全面认识，而多排螺旋CT（multi-slice spiral CT，MSCT）容积扫描结合多平面重建和三维重建能全面、直观、准确地显示胸骨骨折的损伤特征及伴发损伤，对临床诊治有较大帮助。笔者回顾性