胸外伤肋骨骨折的X线检诊

Examination and Diagnosis in Rib Fracture of Thoracic Trauma by X-ray

目的探讨胸外伤所致肋骨骨折的X线检查和诊断,为司法鉴定提供客观依据。方法回顾性分析91例胸外伤肋骨骨折患者,其中男62例,女29例,大多因纠纷、斗殴引起,少部分为撞跌伤,分别摄X线后前位及患侧前(或后)斜位(15°)片,部分为切线位或点片。结果膈上肋骨骨折76例(其中45例发生于腋段,18例发生于后肋背段近胸骨旁线处,10例发生于前肋,3例发生于后肋近肋椎关节处),膈下肋骨骨折15例。结论肋骨骨折因其走行特殊,普通胸部正位片往往会漏诊,辅以患侧前(或后)斜15°多能满足要求,部分间接征象提示有骨折可能者,尚需以透视下点片或患处切线位片。肋骨骨折的有无及多少直接关系到司法量刑。

Objective To explore the X-ray examination and diagnosis in rib fracture caused by chest trauma in an attempt to provide an objective basis for legal identification. Methods A retrospective analysis was made of 91 cases of rib fracture （male 62 and female 29）, mostly caused by disputing or brawling and some caused by hitting or falling. The X-ray film of the posterior-anterior position, oblique （15 degrees） film in the side of hurt and partly tangential position or spot films were taken. Results The X-ray examination showed 76 cases of supradiaphragmatic rib fracture （of which 45 cases occurred in the auxiliary segment, 18 cases in the back section of the rib near the parasternal line, 10 cases in the anterior rib and 3 cases near the rib vertebral joints） and 15 cases of subphrenic rib fracture. Conclusion The ordinary anteroposterior chest films often miss the broken rib due to its special traveling line and a supplement of the hurt side anterior （or posterior） inclined 15 degrees can find the broken position. Some cases of rib fracture with indirect signs still need spot film or lesion tangential position film under fluoroscopy. Presence or absence of rib fracture and how much fracture are directly related to the judicial punishments.