严重胸部创伤16例CT诊断分析

CT diagnosis of severe chest trauma in 16 cases

目的探讨县级医疗机构CT扫描检查对严重胸部创伤的价值。方法使用机型为GEHispeed dual的双层螺旋CT,对我院严重胸部创伤患者16例用胸部螺旋CT以10 mm层厚及间隔进行扫描,部分病灶采用后重建(拆薄)方法,进行观察分析影像。结果 16例严重胸部创伤病例,其中肺挫伤10例,肺撕裂伤2例,支气管断裂伤1例,肺不张2例,肺萎陷10例,血气胸8例,单纯气胸3例,血胸5例;发生肋骨骨折16例,双侧锁骨骨折2例,单侧锁骨骨折3例,第3、4胸椎爆裂性骨折合并椎体侧方脱位及2～4多发肋粉碎性骨折1例,肩胛骨骨折3例。皮下气肿16例,纵隔气肿4例,胸壁血肿1例,肝破裂2例,脾破裂3例,肾破裂1例,颈椎脱位及骨折2例,颅脑损伤4例。结论 CT检查较普通X线检查能提供更多的诊断信息,目前县级医疗机构均有螺旋CT,CT扫描费用也在大幅下调,所以对严重胸部外伤的患者应及时采用CT扫描,以及时明确病变的部位、性质、程度,迅速明确诊断,及时进行手术,挽救危重患者的生命。

Objective To investigate the value of CT examination on the severe chest trauma in medi- cal institutions at county levels. Methods 16 cases with severe chest trauma were undergone chest spiral CT scan with GE Hispeed dual double spiral CT in 10 mm thickness and interval. Some lesions were observed and analyzed by post-reconstruction. Results 16 cases were suffered from severe chest trauma, including pulmona- ry contusion in 10 cases, pulmonary laceration in 2, bronchial rupture in 1, atelectasis in 2, lung collapse in 10, hemopncumothorax in 8, pneumothorax in 3, hemothorax in 5, rib fractures in 16, bilateral clavicle frac- tures in 2, unilateral clavicle fractures in 3, 1 case with vertebral bursffracture （ T3, T4） accompanied with ver- tebral lateral dislocation and multiple rib comminuted fractures, scapula fracture in 3, subcutaneous emphysema in 16, mediastinal emphysema in 4, hematoma of chest wall in 1. Conclusion The CT scan can provide more diagnostic information than ordinary X-ray examination. With the popularity of spiral CT and charge reduction in county hospitals, the patients with severe chest trauma should be timely performed CT scan to get a clear diagno- sis in site, nature and extent of lesions, so as to carry out surgery to save the lives of critical patients.