多层螺旋CT对脊柱爆裂骨折的诊断

The diagnosis of MSCT in spinal burst fracture

目的:通过总结分析多层螺旋CT(MSCT)在脊柱爆裂骨折患者中的影像表现,提高对本病的CT诊断及报告描述水平。方法:回顾分析69例脊柱爆裂骨折患者的MSCT影像,应用多平面重组及不同窗宽窗位进行观察,结合临床资料进行详细统计脊柱内的病变及其他组织病变。结果:69例共75个爆裂椎体,颈椎4(5.3%)个,胸椎10(13.3%)个,胸腰段52(69.3%)个,腰椎9(12%)个;CT影像能对每个椎体骨折部位、骨折线的走向、骨质碎裂分离程度、椎管受压程度、局部后凸Cobb角进行明确的描述。所有病例共显示椎管内明显血肿3例、椎间盘突出14例、远离伤椎的椎间盘突出7例、椎小关节间隙增宽7例、棘突间距增宽5例、棘上韧带增粗模糊18例,显示肋骨骨折12例、肺挫伤9例、血气胸5例、腹腔脏器损伤4例、腹膜后血肿3例。结论:MSCT通过不同算法重建及多平面重组结合,能够明确脊柱爆裂骨折患者中伤椎骨折的部位、形态、成角及椎管受压程度,能够准确的进行Denis分类,能够提示严重的后方韧带复合体及椎间盘损伤,并且能够诊断显示野内其他组织的病变,为临床的治疗提高可靠的依据。

Objective To Improve the CT diagnosis and the level of report description.in patients with spinal burst fracture by studing the MSCTimaging performance.Methods：69 patients with spinal burst fracture were examined by 16-slice spiral CT,and then the imaging features were studied comparatively.Results：Among 69 cases,we founded 75 verterbral bodys with burst fracture,.4（5.3%） cases in cervical,10（13.3%） cases in thoracic,52（69.3%） cases in thoracolumbarand,9（12%）.cases in lumbar.It can be described the fracture location,the direction of fracture line,the separation degree of fracture tablets,the degree of spinal canal compression,the Cobb angle.It can be found 3 cases with obvious hematoma in the spinal canal,14 cases with intervertebral disc protrusion,7 cases with lumbar disc herniation,7 cases with widening of the clearance in vertebral facet joints,5 cases with widening of spike spacing,and 18 cases with thickening of the superior ligament.And it can be found 12 cases with rib fracture,9 cases with pulmonary contusion,5 cases with hemopneumothorax,4cases with abdominal organ injury,3 cases with retroperitoneal hematoma.Conclusion：Multi-modes reconstruction of MSCT can display clearly define the location,the shape and the angle of vertebral fracture,and the degree of compression of vertebral canal,and prompt severe posterior ligamentors complex and disc herniation injury,and diagnose other tissue injuries combined in spinal burst fracture patiens,and prove the reliable basis for clinical treatment.