Collins J
Department of Radiology, University of Wisconsin Hospital and Clinics, Madison 53792-3252, USA.
J Thorac Imaging. 2000 Apr;15(2):112-9. doi: 10.1097/00005382-200004000-00006.
Sufficient trauma to the chest can result in injury to the bony thorax and soft tissues of the chest wall, increasing patient morbidity and mortality. Fractured ribs can lacerate the pleura, lung, or abdominal organs. Fractures to upper ribs, clavicle, and upper sternum can signal brachial plexus or vascular injury. Paradoxical movement of a flail chest can impair respiratory mechanics, promote atelectasis, and impair pulmonary drainage. Most patients with thoracic spine fracture-dislocations have complete neurologic deficits. Scapular fractures, associated with other injuries in almost all patients, are frequently overlooked on supine chest radiographs. Sternal fractures, associated with clinically silent myocardial contusion, are best visualized on chest computed tomography (CT). Severe trauma to the chest wall can be associated with large chest wall hematomas or collections of air within the chest wall that can communicate with the intrathoracic space. CT scanning can easily distinguish chest wall from parenchymal or mediastinal injury, whereas this differentiation my not be possible with chest radiography.
胸部受到足够的创伤可导致胸廓骨骼和胸壁软组织损伤，增加患者的发病率和死亡率。肋骨骨折可划破胸膜、肺或腹部器官。上肋骨、锁骨和上胸骨骨折可能提示臂丛神经或血管损伤。连枷胸的反常运动可损害呼吸力学，促进肺不张，并损害肺引流。大多数胸椎骨折脱位患者存在完全性神经功能缺损。肩胛骨骨折几乎在所有患者中都与其他损伤相关，在仰卧位胸部X线片上常被忽视。与临床上无症状的心肌挫伤相关的胸骨骨折，在胸部计算机断层扫描（CT）上显示最佳。胸壁的严重创伤可伴有大的胸壁血肿或胸壁内与胸腔相通的积气。CT扫描能够轻易区分胸壁损伤与实质或纵隔损伤，而胸部X线摄影可能无法做到这种区分。
