Shapiro M J, Heiberg E, Durham R M, Luchtefeld W, Mazuski J E
Department of Surgery, St. Louis University Health Sciences Center, MO 63110-0250, USA.
Clin Radiol. 1996 Jan;51(1):27-30. doi: 10.1016/s0009-9260(96)80214-5.
There is no gold standard for early and reliable diagnosis of traumatic diaphragmatic rupture (TDR). The purpose of this study is to correlate CT scans, chest radiographs, and intubation on the ability to diagnosis traumatic diaphragmatic rupture.
Twenty patients with blunt trauma induced diaphragmatic rupture were identified from a five year review of a Level 1 Trauma Registry.
Ten of the 20 (50%) patients had TDR on initial chest X-ray, all on the left side. Twelve patients had both chest X-rays and a chest and abdominal CT scan; however, only five (42%) of the CT scans were diagnostic. Of the 12 patients initially intubated, TDR was diagnosed in only four (33%) patients on initial chest X-ray and in one (14%) of seven patients having chest and abdominal CT scans and being intubated.
The early diagnosis of blunt traumatic diaphragmatic rupture, especially in intubated patients, continues to be a diagnostic dilemma. There is a significantly better possibility of identifying left over right-sided TDR (P < or = 0.05). Diagnosing TDR is also facilitated by extubation. If the suspicion exists, a post extubation chest radiograph should be performed to evaluate for TDR.
对于创伤性膈肌破裂（TDR），目前尚无早期且可靠的诊断金标准。本研究旨在关联CT扫描、胸部X线片及插管情况，以评估其对创伤性膈肌破裂的诊断能力。
通过对一级创伤登记系统五年的数据回顾，确定了20例因钝性创伤导致膈肌破裂的患者。
20例患者中，10例（50%）在初次胸部X线检查时发现TDR，均位于左侧。12例患者同时进行了胸部X线检查及胸部和腹部CT扫描；然而，CT扫描仅5例（42%）具有诊断价值。在最初接受插管的12例患者中，初次胸部X线检查仅4例（33%）诊断为TDR，在接受胸部和腹部CT扫描且已插管的7例患者中，仅1例（14%）诊断为TDR。
钝性创伤性膈肌破裂的早期诊断，尤其是在插管患者中，仍然是一个诊断难题。诊断左侧TDR比右侧TDR的可能性显著更高（P≤0.05）。拔管也有助于诊断TDR。如果存在怀疑，应在拔管后进行胸部X线检查以评估是否存在TDR。
