胸部创伤的多层螺旋CT表现及其发生机制_West China Medical Journal

Authors：

董志辉 ¹ ,  杨志刚 ²

Corresponding author：

杨志刚, Email: dongzhih@163.com

Keywords：

胸部; 肋骨; 肺实质; 损伤; 体层摄影术，X线计算机

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【摘要】　胸部创伤很常见，近年来发生率不断增加。该类损伤比较严重，出现连枷胸、大范围肺挫伤、大量气胸和（或）血胸的患者，病死率较高。多层螺旋CT及其三维重组技术能清晰、准确诊断胸部创伤，有助于临床治疗方案的制定、疗效评估和预后判断。现就胸部创伤的影像学表现，主要是CT表现进行综述。

Citation： 董志辉,杨志刚. 胸部创伤的多层螺旋CT表现及其发生机制. West China Medical Journal, 2011, 26(11): 1739-1743. doi: Copy

1.	Mariska ACJ, Jan DM, Margriet EB, et al. Evaluation of trauma care by comparing mortality risks and admission policy in a Dutch trauma region[J]. Injury, 2008, 39(9): 1007-1012.
2.	Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality[J]. Surgery, 2005, 138(4): 717-723.
3.	Holcomb JB, McMullin NR, Kozar RA, et al. Morbidity from rib fractures increases after age 45[J]. J Am Coll Surg, 2003, 196(4): 549-555.
4.	Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures[J]. J Trauma, 1994, 37(6): 975-979.
5.	Clark DE, Fantus RJ. National Trauma Data Bank (NTDB) annual report 2007[M]. Chicago, Ill: American College of Surgeons, 2007: 1-64.
6.	Rathachai K, Laura LA, Ashwin VA, et al. Multidetector CT of Blunt Thoracic Trauma[J]. Radiographics, 2008, 28(6): 1555-1570.
7.	Srinivasan A, Page RD. Blunt injuries of the chest[J]. Surgery, 2004, 22(5): 114-116.
8.	Lomoschitz FM, Eisenhuber E, Linnau KF, et al. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms[J]. Eur J Radiol, 2003, 48(1): 61-70.
9.	Kaiser ML, Whealon MD, Barrios C, et al. Risk Factors for Traumatic injury findings on thoracic computed tomography among patients with blunt trauma having a normal chest radiograph[J]. Arch Surg, 2011, 146(4): 459-463.
10.	Sirmali M, Turut H, Topcu S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management[J]. Eur J Cardiothorac Surg, 2003, 24(1): 133-138.
11.	Freixinet J, Beltran J, Rodriguez PM, et al. Indicators of Severity in Chest Trauma[J]. Arch Bronconeumol, 2008, 44(5): 257-262.
12.	Dong ZH, Yang ZG, Chu ZG, et al. Crush Thoracic Trauma in the Massive Sichuan Earthquake: evaluation with Multi-detector CT of 223 cases[J]. Radiology, 2010, 254(1): 285-291.
13.	Dong ZH, Yang ZG, Chu ZG, et al. Thoracic injuries between earthquake-related versus non-earthquake-related traumas patients: differentiation with MDCT[J]. Clinics, 2011, 66(5): 817-822.
14.	Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden[J]. Injury, 2000, 31(5): 353-358.
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16.	Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J]. Spine, 1983, 8(8): 817-831.
17.	Wolter D. Classification and prognosis of spinal injuries[J]. Langenbecks Arch Chir, 1988(Suppl 2): 237-243.
18.	Demirhan R, Onan B, Oz K, et al. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience[J]. Interact CardioVasc Thora Surg, 2009, 9(3): 450-453.
19.	Miller LA. Chest wall, lung, and pleural space trauma[J]. Radiol Clin North Am, 2006, 44(2): 213-224.
20.	Livingston DH, Haurer CJ. Trauma to the chest wall and lung[M]//Moore EE, Feliciano DV, Mattox KL. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004: 507-537.
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22.	Andrew M, Anthony A, John H. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010[J]. Thorax, 2010, 65(Suppl 2): 18-31.
23.	De Moya MA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system[J]. J Trauma, 2007, 63(1): 13-17.
24.	Wagner RB, Crawford WO, Schimpf PP. Classification of parenchymal injuries of the lung[J]. Radiology, 1988, 167(1): 77-82.
25.	Balci AE, Kazez A, Eren S, et al. Blunt thoracic trauma in children: review of 137 cases[J]. Eur J Cardiothorac Surg, 2004, 26(2): 387-392.
26.	Riley RD, Miller PR, Meredith JW. Injury to the esophagus, trachea and bronchus[M]//Moore EE, Feliciano DV, Mattox KL. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004: 539-552.
27.	Euathrongchit J, Thoongsuwan N, Stern EJ. Nonvascular mediastinal trauma[J]. Radiol Clin North Am, 2006, 44(2): 251-258.
28.	Chen JD, Shanmuganathan K, Mirvis SE, et al. Using CT to diagnose tracheal rupture[J]. Am J Roentgenol, 2001, 176(5): 1273-1280.
29.	Scaglione M, Romano S, Pinto A, et al. Acute tracheobronchial injuries: impact of imaging on diagnosis and management implications[J]. Eur J Radiol, 2006, 59(3): 336-343.
30.	Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications[J]. Arch Intern Med, 1939, 64(5): 913-926.
31.	Turan AA, Karayel FA, Akyildiz E, et al. Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern[J]. J Forensic Sci, 2010, 55(1): 82-84.
32.	Teixeira PG, Inaba K, Oncel D, et al. Blunt cardiac rupture: a 5-year NTDB analysis[J]. J Trauma, 2009, 67(4): 788-791.
33.	El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma[J]. J Emerg Med, 2008, 35(2): 127-133.
34.	Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma[J]. J Trauma, 1997, 42(3): 374-380.
35.	Scaglione M, Pinto A, Pinto F, et al. Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma[J]. Eur Radiol, 2001, 11(12): 2444-2448.
36.	Parker MS, Matheson TL, Rao AV, et al. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries[J]. Am J Roentgenol, 2001, 176(5): 1267-1272.
37.	Blanke P, Bulla S, Baumann T, et al. Thoracic Aorta: prospective electrocardiographically triggered CT angiography with dual-source CT-feasibility, image quality, and dose reduction[J]. Radiology, 2010, 255(1): 207-217.
38.	Pabon-Ramos WM, Williams DM, Strouse PJ. Radiologic evaluation of blunt thoracic aortic injury in pediatric patients[J]. AJR, 2010, 194(5): 1197-1203.
39.	Lewis JD, Starnes SL, Pandalai PK, et al. Traumatic diaphragmatic injury: experience from a level I trauma center[J]. Surgery, 2009, 146(4): 578-583.
40.	Sliker CW. Imaging of diaphragm injuries[J]. Radiol Clin North Am, 2006, 44(2): 199-211.
41.	Chen HW, Wong YC, Wang LJ, et al. Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: experience with 43 patients[J]. Clin Radiol, 2010, 65(3): 206-212.
42.	Shanmuganathan K. Imaging of diaphragmatic injuries[J]. J Thoracic Imaging, 2000, 15(2): 104-111.
43.	Bodanapally UK, Shanmuganathan K, Mirvis SE, et al. MDCT diagnosis of penetrating diaphragm injury[J]. Eur Radiol, 2009, 19(8): 1875-1881.

1. 　Mariska ACJ, Jan DM, Margriet EB, et al. Evaluation of trauma care by comparing mortality risks and admission policy in a Dutch trauma region[J]. Injury, 2008, 39(9): 1007-1012.
2. 　Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality[J]. Surgery, 2005, 138(4): 717-723.
3. 　Holcomb JB, McMullin NR, Kozar RA, et al. Morbidity from rib fractures increases after age 45[J]. J Am Coll Surg, 2003, 196(4): 549-555.
4. 　Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures[J]. J Trauma, 1994, 37(6): 975-979.
5. 　Clark DE, Fantus RJ. National Trauma Data Bank (NTDB) annual report 2007[M]. Chicago, Ill: American College of Surgeons, 2007: 1-64.
6. 　Rathachai K, Laura LA, Ashwin VA, et al. Multidetector CT of Blunt Thoracic Trauma[J]. Radiographics, 2008, 28(6): 1555-1570.
7. 　Srinivasan A, Page RD. Blunt injuries of the chest[J]. Surgery, 2004, 22(5): 114-116.
8. 　Lomoschitz FM, Eisenhuber E, Linnau KF, et al. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms[J]. Eur J Radiol, 2003, 48(1): 61-70.
9. 　Kaiser ML, Whealon MD, Barrios C, et al. Risk Factors for Traumatic injury findings on thoracic computed tomography among patients with blunt trauma having a normal chest radiograph[J]. Arch Surg, 2011, 146(4): 459-463.
10. 　Sirmali M, Turut H, Topcu S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management[J]. Eur J Cardiothorac Surg, 2003, 24(1): 133-138.
11. 　Freixinet J, Beltran J, Rodriguez PM, et al. Indicators of Severity in Chest Trauma[J]. Arch Bronconeumol, 2008, 44(5): 257-262.
12. 　Dong ZH, Yang ZG, Chu ZG, et al. Crush Thoracic Trauma in the Massive Sichuan Earthquake: evaluation with Multi-detector CT of 223 cases[J]. Radiology, 2010, 254(1): 285-291.
13. 　Dong ZH, Yang ZG, Chu ZG, et al. Thoracic injuries between earthquake-related versus non-earthquake-related traumas patients: differentiation with MDCT[J]. Clinics, 2011, 66(5): 817-822.
14. 　Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden[J]. Injury, 2000, 31(5): 353-358.
15. 　Hardegger FH, Simposon LA, Weber BG. The operative treatment of scapular fractures[J]. J Bone Joint Surg (Br), 1984, 66(5): 725-731.
16. 　Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J]. Spine, 1983, 8(8): 817-831.
17. 　Wolter D. Classification and prognosis of spinal injuries[J]. Langenbecks Arch Chir, 1988(Suppl 2): 237-243.
18. 　Demirhan R, Onan B, Oz K, et al. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience[J]. Interact CardioVasc Thora Surg, 2009, 9(3): 450-453.
19. 　Miller LA. Chest wall, lung, and pleural space trauma[J]. Radiol Clin North Am, 2006, 44(2): 213-224.
20. 　Livingston DH, Haurer CJ. Trauma to the chest wall and lung[M]//Moore EE, Feliciano DV, Mattox KL. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004: 507-537.
21. 　Kiecher LT, Swartzel RL. Spontaneous pneumothorax and its treatment[J]. JAMA, 1954, 155(1): 24-29.
22. 　Andrew M, Anthony A, John H. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010[J]. Thorax, 2010, 65(Suppl 2): 18-31.
23. 　De Moya MA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system[J]. J Trauma, 2007, 63(1): 13-17.
24. 　Wagner RB, Crawford WO, Schimpf PP. Classification of parenchymal injuries of the lung[J]. Radiology, 1988, 167(1): 77-82.
25. 　Balci AE, Kazez A, Eren S, et al. Blunt thoracic trauma in children: review of 137 cases[J]. Eur J Cardiothorac Surg, 2004, 26(2): 387-392.
26. 　Riley RD, Miller PR, Meredith JW. Injury to the esophagus, trachea and bronchus[M]//Moore EE, Feliciano DV, Mattox KL. Trauma. 5th ed. Philadelphia, Pa: McGraw-Hill, 2004: 539-552.
27. 　Euathrongchit J, Thoongsuwan N, Stern EJ. Nonvascular mediastinal trauma[J]. Radiol Clin North Am, 2006, 44(2): 251-258.
28. 　Chen JD, Shanmuganathan K, Mirvis SE, et al. Using CT to diagnose tracheal rupture[J]. Am J Roentgenol, 2001, 176(5): 1273-1280.
29. 　Scaglione M, Romano S, Pinto A, et al. Acute tracheobronchial injuries: impact of imaging on diagnosis and management implications[J]. Eur J Radiol, 2006, 59(3): 336-343.
30. 　Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications[J]. Arch Intern Med, 1939, 64(5): 913-926.
31. 　Turan AA, Karayel FA, Akyildiz E, et al. Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern[J]. J Forensic Sci, 2010, 55(1): 82-84.
32. 　Teixeira PG, Inaba K, Oncel D, et al. Blunt cardiac rupture: a 5-year NTDB analysis[J]. J Trauma, 2009, 67(4): 788-791.
33. 　El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma[J]. J Emerg Med, 2008, 35(2): 127-133.
34. 　Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma[J]. J Trauma, 1997, 42(3): 374-380.
35. 　Scaglione M, Pinto A, Pinto F, et al. Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma[J]. Eur Radiol, 2001, 11(12): 2444-2448.
36. 　Parker MS, Matheson TL, Rao AV, et al. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries[J]. Am J Roentgenol, 2001, 176(5): 1267-1272.
37. 　Blanke P, Bulla S, Baumann T, et al. Thoracic Aorta: prospective electrocardiographically triggered CT angiography with dual-source CT-feasibility, image quality, and dose reduction[J]. Radiology, 2010, 255(1): 207-217.
38. 　Pabon-Ramos WM, Williams DM, Strouse PJ. Radiologic evaluation of blunt thoracic aortic injury in pediatric patients[J]. AJR, 2010, 194(5): 1197-1203.
39. 　Lewis JD, Starnes SL, Pandalai PK, et al. Traumatic diaphragmatic injury: experience from a level I trauma center[J]. Surgery, 2009, 146(4): 578-583.
40. 　Sliker CW. Imaging of diaphragm injuries[J]. Radiol Clin North Am, 2006, 44(2): 199-211.
41. 　Chen HW, Wong YC, Wang LJ, et al. Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: experience with 43 patients[J]. Clin Radiol, 2010, 65(3): 206-212.
42. 　Shanmuganathan K. Imaging of diaphragmatic injuries[J]. J Thoracic Imaging, 2000, 15(2): 104-111.
43. 　Bodanapally UK, Shanmuganathan K, Mirvis SE, et al. MDCT diagnosis of penetrating diaphragm injury[J]. Eur Radiol, 2009, 19(8): 1875-1881.

West China Medical Journal

胸部创伤的多层螺旋CT表现及其发生机制

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