多排螺旋CT血管成像在下肢骨折后伴发隐匿性血管损伤中的初步应用  

Preliminary application of multidetector CT angiography in patients with fractures in lower extremities accompanied with occult vascular injuries

作　　者：宋国平[1] 李跃华[1] 陈宇杰[2] 

机构地区：[1]上海交通大学附属第六人民医院放射科,上海200233 [2]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《实用放射学杂志》2012年第3期441-444,共4页Journal of Practical Radiology

摘　　要：目的 总结多排螺旋CT血管成像（MSCTA）对下肢骨折后伴发血管不典型损伤的诊断价值.方法 回顾性分析本院2007-09-2010-10收治的下肢骨折及脱位患者的临床资料进行筛选,将初诊时没有明显动脉损伤、臂踝指数＜0.9而行MSCTA检查,且经手术探查或DSA治疗的39例患者列为本次研究的对象.结果 39例患者共有42处骨折和2处脱位,其初诊平均臂踝指数为0.72±0.21.MSCTA结果显示28例患者存在血管损伤,共有32侧肢体血管损伤,大腿段9侧（31.0%）,膝段17侧（55.2%）,小腿段6侧（13.8%）,其中多发血管损伤共有6侧（20.7%）,2处损伤有4侧（13.8%）,多于2处损伤有2侧（6.9%）,另有11例患者为阴性.28例MSCTA阳性的患者均经手术探查及修复,证实14例血管断裂,6例血管部分断裂,血管挫伤2例,血管内膜损伤伴血栓形成3例,血管血栓栓塞3例.另11例MSCTA阴性的患者在随访过程中出现动脉损伤症状,遂进行DSA检查及球囊扩张和经皮腔内血管成形术（PTA）治疗,最终证实有2例为血管部分断裂.最终结果表明,MSCTA显示隐匿性血管损伤的敏感度为93.5%,特异性为75%,准确性为88.4%.结论 MSCTA对骨折后是否存在隐匿性血管损伤具有一定的诊断价值,可以提高手术探查成功率及降低探查阴性率.Objective To investigate the diagnostic value of multidetector CT angiography（MSCTA） in patients with fractures m lower extremities accompanied with occult vascular injuries. Methods 39 patients with fractures or dislocations in lower extremities in our hospital from September 2007 to October 2010 ,whose initial ankle-brachial index （ ABI） less than 0.9, but without significant arterial injury symptoms underwent MSCTA, surgical operation or DSA interventional therapy. Results A total of 39 patients with 42 fractures and 2 dislocations were detected. The initial average ABI was 0.72±0.21. Thirty-two arterial injuries were detected by MSCTA in 28 patients, including 9 arterial iniuries in the thigh （31.0%）, 17 in the knee （55.2%）, 6 in the calf （13.8%） respec- tively. Among those, there were 6 patients with multiple arterial injuries（ 20.7 %） , 4 with two different vascular injuries （ 13.8% ） , 2 with more than two different vascular injuries （6.9%） ,the rest of the patients had negative results. All 28 patients with positive results at MSCTA experienced timely exploratory operation and repair procedure. It was convinced that there were 14 patients with contusions, 3 with intimal injuries accompanied with complete vascular ruptures, 6 with partial vascular ruptures, 2 with vascular results at MSCTA appeared vascular iniury symptoms regional thrombosis, 3 with thromboembolism. All 11 patients with negative in close follow-up- Then DSA examination, balloon dilation and percutaneous transluminal angioplasty（PTA） were performed. Finally it was demonstrated that 2 patients had partial arterial ruptures. The sensibility, specificity and accuracy of MSCTA in detection for occult vascular injuries were 93.5 %, 75 % and 88.4% , respectively. Conclusion MSCTA is of important diagnostic value to evaluate whether there are occult vascular iniuries in patients with fractures or dislocations. MSCTA may improve enormously posi tive rate of surgical exploration.

关 键 词：骨折 血管损伤 体层摄影术 X线计算机 血管成像 

分 类 号：R683[医药卫生—骨科学] R543[医药卫生—外科学]