| 隐匿性骨盆后环损伤的影像学表现及临床意义 |
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投稿时间：2008-09-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 李明 |
LI Ming |
宁波市第六医院创伤骨科，浙江 宁波 315040 |
Department of Orthopaedics, Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 徐荣明 |
XU Rong-ming |
宁波市第六医院创伤骨科，浙江 宁波 315040 |
Department of Orthopaedics, Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 郑琦 |
Zheng Qi |
杭州市红会医院骨科 |
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| 校佰平 |
XIAO Bai-ping |
宁波市第六医院创伤骨科，浙江 宁波 315040 |
Department of Orthopaedics, Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 王国平 |
WANG Guo-ping |
宁波市第六医院放射科 |
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| 期刊信息：《中国骨伤》2008年，第21卷，第11期，第810-813页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的： 探讨临床容易忽视的隐匿性骨盆后环损伤的影像学表现及其临床意义。
方法：调阅2003年1月至2008年1月我院影像学资料完整的178例骨盆创伤病历，发现21例骨盆CR正位片显示后环正常或疑似损伤，调阅其骨盆螺旋CT发现其中17例均有骨盆后环损伤，其中男11例，女6例；年龄19～71岁，平均34.7岁。螺旋CT检查方法：平描层厚3 mm,同时做冠状面、矢状面及骶骨曲面重建。对CR片及CT图像进行横向对照，结合患者临床情况进行分析研究。
结果：17例中CR正位片显示骨盆前环耻、坐骨支骨折或耻骨联合损伤。CT多维重建显示后环骶骨骨折DenisⅠ型5例、Ⅱ型5例、Ⅲ型2例，骶髂关节分离移位1例，骶骨合并髂骨后部骨折4例。按受伤机制分析，17例漏诊患者中15例属于侧方挤压暴力导致的内旋损伤，2例属于前后挤压暴力导致的外旋损伤，按Young-Burgess分型：LCⅠ型11例、Ⅱ型4例和APC Ⅰ型2例；按Tlie和AO分型均为B型旋转不稳定。资料CR正位片骨盆后环骨折确诊率为89%.螺旋CT横断面、冠状面、矢状面和骶骨曲面4个面的重建同时应用，对微细骨折检出率为100%.
结论：螺旋CT 4个面的重建同时应用是确诊骨盆后环骨折的 ”金标准“,为更精确的诊断提供科学依据，降低并发症，减少漏诊率。 |
| 【关键词】骨盆环 损伤 螺旋CT |
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| Imaging diagnose and clinical meaning for easy neglect occult posterior pelvic ring injury |
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ABSTRACT
Objective: To study the value of imaging diagnose and clinical meaning for easy neglect occult posterior pelvic ring injury.
Methods: From Jan.2003 to Jan.2008,178 patients with trauma of pelvic ring were reviewed. Routine AP view of pelvic computed radiographs(CR),axial,sagittal,coronal and curve multiplanar reconstruction CT(MPR)were performed. Spiral CT, slice thickness 3 mm,was carried out in all patients. There were 17 patients(11 males,6 females,aged 19 to 71 years,mean 34.5 years) with obturator foramen aera fracture obviously but suspecting fracture or normal in posterior pelvic ring in AP view, which had imperceptible fracture changes in MPR. Routine radiographs and CT images studies and clinical physical examination correlation were evaluated retrospectively by anatomical region and classified using the Young-Burgess classification,Tile and AO classification.
Results: In the remaining 17 patients with suspected fracture or normal in posterior pelvic ring,5 cases of Denis I type of sacral fracture,5 cases of Denis II type,2 cases of Denis III type,1 case of sacroilliac joint dislocation,4 cases of sacral combined with posterior illiac fracture were diagnosed by MPR. Pelvic fracture categories were derived by adapting the Young-Burgess pelvic fracture classification scheme:lateral compression(LC)I and II, anteroposterior compression(APC) I. By adapting the Tile and AO classification schemes,the fracture were B1 and B2 type seperately. From the mechanism of trauma and assessment of pelvic stability point view,15 cases were internal rotational unstability by lateral compression force, 2 cases were external rotation unstability by anteroposterior force. The omitted rate of posterior pelvic ring was 11%(17 of 128) by routine AP view of CR. 4D imaging reconstruction technique of spiral CT could detect all type of pelvic ring fractures (100%).
Conclusion: MPR CT could detect imperceptible fractures not been seen on AP view of CR of posterior pelvic ring and visualized sacral fractures better than the axial source images. MPR CT is accurate and reliable in occult posterior pelvic ring fracture for correct fracture detection and classification and guide therapeutic decision-making in patients with pelvic ring trauma. |
| KEY WORDS Pelvic ring Injuries Spiral CT |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李明,徐荣明,郑琦,校佰平,王国平.隐匿性骨盆后环损伤的影像学表现及临床意义[J].中国骨伤,2008,21(11):810~813 |
| 英文格式: | LI Ming,XU Rong-ming,Zheng Qi,XIAO Bai-ping,WANG Guo-ping.Imaging diagnose and clinical meaning for easy neglect occult posterior pelvic ring injury[J].zhongguo gu shang / China J Orthop Trauma ,2008,21(11):810~813 |
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