钝性喉气管损伤的MSCT诊断

Multi-slice CT in the diagnosis of blunt laryngotracheal trauma

目的:探讨多层螺旋CT在钝性喉气管损伤(B-LTT)中的临床应用价值。方法:对喉颈部外伤后156例患者使用GE LightSpeed 16层及32层螺旋CT设备行CT检查,其中平扫111例和对比剂增强扫描45例,并通过最大密度投影(MIP)、多平面重组(MPR)、仿真内镜(VE)及容积再现(VR)等影像后处理技术进行喉软骨、喉部软组织三维成像。结果:共发现43例患者喉部损伤,包括软组织损伤28例,喉软骨骨折14例及舌骨骨折1例。喉软骨骨折14例中,甲状软骨骨折12例(右侧甲状软骨5例,左侧甲状软骨骨折3例,甲状软骨前部正中骨折4例)。同时合并环状软骨骨折3例,杓状软骨骨折2例,环杓关节脱位3例,环甲关节脱位2例,甲状腺损伤2例,皮下气肿12例,咽喉部血肿3例,颈2椎体骨折1例。MSCT显示喉软骨骨折的直接征象为喉软骨边缘不连续,可见低密度骨折线影,也可伴移位。软组织损伤表现为声门及气道狭窄,伴咽喉部血肿、皮下气肿。喉周围软组织内出现气泡是喉黏膜撕裂的间接征象。结论:螺旋CT可多方位显示喉软骨骨折部位、程度以及气道狭窄和喉黏膜撕裂情况,是诊断喉损伤快速有效的方法。

Objective：To evaluate the value of multi-slice spiral computed tomography（MSCT） in blunt laryngotracheal trauma（B-LTT）.Methods：MSCT was performed in 156 patients with B-LTT including 111 patients had plain CT and 45 patients had enhanced CT,3-dimensional images of laryngeal cartilages and soft tissues were obtained with post-processing reconstruction techniques including MIP、MPR、VE and VR.Results：Altogether 43 patients were found to have laryngeal injuries including soft tissue injury（n=28）,laryngeal cartilage fracture（n=14） and hyoid fracture（n=1）.In 14 patients having laryngeal cartilage fracture,there were thyroid cartilage fracture（n=12;with right side,n=5,left side,n=3,anterior-median area n=4）.Concurrently complicated cricoid cartilage fracture（n=3）,arytenoid cartilage fracture（n=2）,dislocation of crico-thyroid joint（n=2） and crico-arytenoid joint（n=3）;thyroid injury（n=2）,subcutaneous emphysema（n=12）,pharyngeal/ laryngeal hematoma（n=3） and fracture of the second cervical vertebral body（n=1）.The direct sign of laryngeal cartilage fracture was showed as discontinuity of its contour/margin,low density fracture line,and might be accompanied with displacement.The sign of soft tissue injury was showed as stenosis of glottis and airway,accompanied with pharyngeal/laryngeal hematoma and/or subcutaneous emphysema.＂Gas bubble＂ sign within peri-paralaryngeal soft tissue was the indirect sign of mucous membrane laceration.Conclusion：The location,degree of laryngeal fracture as well as stenosis of airway and laceration of laryngeal mucous membrane could be revealed on MSCT with multi-planar display,which is a fast and effective approach for the diagnosis of laryngeal injuries.