MRA及CTA对地震挤压伤血管病变的诊断价值及术后评价
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摘要
目的:探讨磁共振血管造影(MRA)以及计算机断层扫描血管成像(CTA)对地震挤压伤下肢血管病变的临床价值。方法:对5.12汶川大地震中我院收治的已确诊为地震挤压伤致双下肢横纹肌溶解症3例患者进行双下肢MRA检查,并对严重挤压伤及下肢毁损,并行截肢的另三名患者进行术后CTA检查。对MRA图象双下肢动脉进行回顾性分析,总结MRA征象,同时总结截肢术后患者CTA表现及临床价值,并评价二者检查在挤压伤所至横纹肌溶解症的临床诊治中的作用。结果:3例未行截肢患者MRA双下肢主要动脉未见确切狭窄及闭塞征象,管腔内未见充盈缺损影。3例已行截肢患者可见残余肢体的明显肿胀,双侧髂血管以及部分截断肢体远端血管内见止血弹簧钢圈影像,部分截断肢体远端动脉分支变细。截断血管未见再通,周围无渗血改变。结论:MRA、CTA能直观显示双下肢动脉损伤及术后情况,在临床应用中各有优势和局限性。对二者的合理选择能为临床诊治提供有利信息。
Objective:To evaluate the application of Magnetic Resonance Angiography(MRA)and computed tomography Angiography(CTA)in vesselar lesions of low extremities caused by crush injury after Wenchuan earthquake.Methods:MRA was performed on three patients with crush injury,and CTA was performed on other three patients with sever severe crush injury after amputation.We retrospectively evaluated the MRA and CTA images as well as the their clinic application and values on crush injury.Results:There are no signs of arterial occlusion、arteriostenosis and filling defect on MRA of three patients.CTA showed clearly the blockage of main artery in stump and the thinning of blood vessels in stump as well as swelling in soft tissue.Conclusion:MRA and CTA both can directly display the conditions of vascular lesions and the post-operation,so they are very important and useful technique in the diagnosis and guidance of treatment of crush injury,but with different indications and limitations which should be selectively used in different conditions.
Objective:To evaluate the application of Magnetic Resonance Angiography(MRA)and computed tomography Angiography(CTA)in vesselar lesions of low extremities caused by crush injury after Wenchuan earthquake.Methods:MRA was performed on three patients with crush injury,and CTA was performed on other three patients with sever severe crush injury after amputation.We retrospectively evaluated the MRA and CTA images as well as the their clinic application and values on crush injury.Results:There are no signs of arterial occlusion、arteriostenosis and filling defect on MRA of three patients.CTA showed clearly the blockage of main artery in stump and the thinning of blood vessels in stump as well as swelling in soft tissue.Conclusion:MRA and CTA both can directly display the conditions of vascular lesions and the post-operation,so they are very important and useful technique in the diagnosis and guidance of treatment of crush injury,but with different indications and limitations which should be selectively used in different conditions.
引文
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[5]EREN N,OZGEN G,GUREL A,et al.Vascular injuries and am-putation following limb fractures[J].Thorac Cardiovasc Surg,1990,38:48-50.
[6]ONO H,NAKAGAWA Y,MIZUMOTO S,et al.Evaluation ofvascular compliance and vasoconstrictive reactions in amputatedhindlimbs of rats[J].J Orthop Res,1995,13:375-81.
[7]王佩芬,周康荣,陈祖望,等.下肢动脉慢性闭塞症的MRA诊断[J].中华放射学杂志,1997,31(6):396-399.
[8]陈振松,孟志华,杨昂,等.三维增强MRA在外伤性下肢血管损伤的应用价值[J].实用医技杂志,2005,12(10):2852-2854.
[9]ADAMIS MK,LI W,WIELOPOLSKI PA,et al.Dynamic contrast-enhanced subtraction MR angiography of the lower extremities:in-itial evaluation with a multisection two-dimensional time-of-flightsequence[J].Radiology,1995,196:689-95.
[10]仲海,徐卓东,柳澄,赵晓红.64层螺旋CT血管成像对下肢动脉系统疾病的应用价值[J].医学影像学杂志,2005,15(11):988-991.
[2]ASHWORTH EM,DALSING MC,GLOVER JL,et al.Lower ex-tremity vascular trauma:a comprehensive,aggressive approach[J].J Trauma,1988,28:329-36.
[3]LANGE RH.Limb reconstruction versus amputation decisionmaking in massive lower extremity trauma[M].Clin Orthop RelatRes,1989:92-9.
[4]戴力扬.严重下肢创伤截肢手术指征的选择[J].中华外科杂志,1998,36(5):284-286.
[5]EREN N,OZGEN G,GUREL A,et al.Vascular injuries and am-putation following limb fractures[J].Thorac Cardiovasc Surg,1990,38:48-50.
[6]ONO H,NAKAGAWA Y,MIZUMOTO S,et al.Evaluation ofvascular compliance and vasoconstrictive reactions in amputatedhindlimbs of rats[J].J Orthop Res,1995,13:375-81.
[7]王佩芬,周康荣,陈祖望,等.下肢动脉慢性闭塞症的MRA诊断[J].中华放射学杂志,1997,31(6):396-399.
[8]陈振松,孟志华,杨昂,等.三维增强MRA在外伤性下肢血管损伤的应用价值[J].实用医技杂志,2005,12(10):2852-2854.
[9]ADAMIS MK,LI W,WIELOPOLSKI PA,et al.Dynamic contrast-enhanced subtraction MR angiography of the lower extremities:in-itial evaluation with a multisection two-dimensional time-of-flightsequence[J].Radiology,1995,196:689-95.
[10]仲海,徐卓东,柳澄,赵晓红.64层螺旋CT血管成像对下肢动脉系统疾病的应用价值[J].医学影像学杂志,2005,15(11):988-991.
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