摘要
目的探讨飞利浦256层极速CT血管成像(computedtomography angiography,CTA)对外伤性下肢血管损伤情况的评估及其临床应用价值。方法回顾性分析2016年1月至2018年9月共68例下肢骨折患者双下肢血管CTA图像(VR、MPR、CPR、MIP等),其中术前22例,骨折内固定术后46例,评估下肢血管损伤情况及术后修复情况。结果①阴性病例8例;阳性病例60例,共76个骨折部位,股骨段15例(19.7%),膝部8例(10.5%),胫腓骨段32例(42.1%),跗骨及跖趾骨段21例(27.7%),其中小腿截肢患者3例、小腿离断患者2例。②MSCTA发现88根病变血管,包括22例血管断裂或部分断裂,28例血管内膜损伤并血栓形成,19例血管栓塞,13例动静脉瘘,6例假性动脉瘤;其中3例患者小腿动脉因金属伪影较大难以评估,5例患者虽有金属伪影,但下肢血管显影可,能够满足临床诊断要求。③以手术证实或DSA结果为标准,MSCTA对下肢血管损伤情况评估的准确性为96.6%,敏感性100%,特异性72.7%,误诊率27.3%,漏诊率0。结论飞利浦256层双下肢CTA可以准确评估下肢外伤后是否存在血管损伤及其损伤程度,提高了手术探查、术中血管修复的成功率,可作为下肢外伤血管损伤评估的首选检查方法。
Objective To evaluate the computed tomography(CTA)of philips 256-slice computed tomography on traumatic vascular injury of lower limbs and its clinical application.Methods The CTA images of bilateral lower limb vessels(VR,MPR,CPR,MIP,etc.)of 68 patients with lower limb fractures from January 2016 to September 2018 were analyzed retrospectively,including 22 cases before surgery and 46 cases after internal fixation of fractures,to evaluate the vascular injury and postoperative repair of lower limbs.Results①There were 8 negative cases;There were 60 positive cases,including 76 fracture sites,15 cases of femoral segment(19.7%),8 cases of knee(10.5%),32 cases of tibiofibular segment(42.1%),21 cases of tarsal bone and metatarsal phalangeal segment(27.7%),including 3 cases of leg amputation and 2 cases of leg amputation.②MSCTA found 88 diseased vessels,including 22 cases of vascular rupture or partial rupture,28 cases of endovascular injury and thrombosis,19 cases of vascular thromboembolism,13 cases of arteriovenous fistula,and 6 cases of pseudoaneurysm.Among them,it was difficult to evaluate the lower leg artery of 3 patients due to the large metal artifact.Although 5 patients had metal artifact,the vascular development of lower limbs was acceptable,which could meet the requirements of clinical diagnosis.③with surgical confirmation or DSA results as the standard,the accuracy of MSCTA in the assessment of vascular injury of lower limbs was 96.6%,the sensitivity was 100%,the specificity was 72.7%,the misdiagnosis rate was 27.3%,and the missed diagnosis rate was 0.Conclusion Philips 256-layer doublelower limb CTA can assess whether there is vascular injury and the degree of injury after lower limb trauma accurately,helps to improve the success rate of surgical exploration and intraoperative vascular repair,which can be used as the preferred examination method for the assessment of vascular injury after lower limb trauma.
作者
梁文娇
贾喆
高文治
武辽军
LIANG Wen-jiao;JIA Zhe;GAO Wen-zhi(Second Hospital of Yulin,Yulin 719000,Shaanxi Province,China)
出处
《中国CT和MRI杂志》
2019年第9期143-146,共4页
Chinese Journal of CT and MRI
关键词
双下肢CTA
下肢骨折
血管损伤
Double Lower Extremity Vascular CTA
Lower Limb Fracture
Vascular Injury
