多影像技术在枪弹伤诊治中的应用

Application of Multiple Imaging Techniques in the Diagnosis and Treatment of Gunshot Wounds

目的探讨X线检查、C臂透视、CT、超声及磁共振等影像技术在枪弹伤救治中的的具体方法应用价值。方法回顾性分析39例枪弹伤患者的医学影像学图片及病历资料。结果39例38行X线检查,明确体内有无弹丸碎片存留及其初步定位,29例伤情复杂再行CT扫描以精确定位碎片、探查合并伤,19例进行超声探测以明确中弹弹道情况,2例磁共振检查关节伤情,清创术中23例结合C臂透视下再定位,血管行彩色多谱勒及CTA检查。根据伤情,早期急救行弹丸清除和弹道清创术,复杂合并伤于二期手术处理。除1例颅脑枪伤死亡,其余术后预后良好。结论枪弹伤诊治中,联合应用X线检查、C臂透视、CT、超声及磁共振等影像技术有利于充分观察弹丸位置、判断弹道伤情及合并伤,从而实现治疗效果。

ObjectiveTo discuss the application value of X-ray,C-arm fluoroscopy,computed tomography(CT),ultrasound and magnetic resonance imaging(MRI)in the treatment of gunshot wounds(GSW).MethodsA retrospective analysis was made to the the medical images and clinical data of 39 GSW cases.ResultsX-ray examinations was performed on 38 cases out of the 39 so as to detect retained bullet fragments(RBF)and to make preliminary positioning of RBF;additonal CT scannings were given to 29 cases with complex wounds so as to make accurate positioning of GSW and to detect the combined injuries;19 cases were given ultrasound examinations to observe wound ballistics;2 cases were given MRI to observe the wounds of joints;23 cases were given combined repositioning of RBF with C-arm fluoroscopy,Color Doppler flow imaging(CDFI)and CT angiography(CTA)were made to the 23 cases receiving debridement;based on wound severity,bullet removal and ballistic debridement were provided in the first aid and second-stage surgery was given to those with complex joint injury;1 died of brain GSW and the rest were of good prognosis.ConclusionsComprehensive application of medical imaging techniques is of great help in making clear the bullet position and judging the severity of ballistic and combined injuries so as to reach the satisfactory curative effect.