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目的通过对相关鉴定资料回顾性分析,探讨影像学检查对道路交通伤致股骨头缺血性坏死(ANFH)早期诊断的价值。方法选择2013年1月至2014年2月期间,唐山华北法医鉴定所受理的交通伤致股骨头缺血坏死的案例资料43例。根据资料调查表,对主诉、临床症状、体征进行分析;按照Froberg标准分期对X线、CT、MRI影像学检查结果进行统计。结果 43例均存在自觉症状和不同程度的阳性体征。30例X线改变不明显,其中有50%经CT检查确诊为ANFHⅠ期;CT显示Ⅱ、Ⅲ、Ⅳ期者,较X线诊断均晚一期;MRI诊断Ⅰ期的2例,CT为Ⅰ期;MRI诊断为Ⅱ期34例,CT为Ⅰ期;MRI诊断为Ⅲ、Ⅳ期者,均较CT诊断晚1~2期。结论 X线摄片是交通伤致髋部损伤后的基础性检验,对是否进一步检验具有提示作用;CT扫描是判断ANFH的首选,也是指导手术的必备资料;MRI成像是诊断ANFH最佳手段。在道路交通伤残的评定时可根据需要选择最适宜的检查手段,而鉴定时限可选择为一年或一年半以上。
Objective To retrospectively analyze the related identification data to explore the value of imaging examination in early diagnosis of avascular necrosis of femoral head (ANFH) caused by road traffic injuries. Methods From January 2013 to February 2014, 43 cases of cases of avascular necrosis of the femoral head accepted by North China Forensic Medical Examination of Tangshan were selected. The main complaint, clinical symptoms and signs were analyzed according to the data questionnaire. The X-ray, CT and MRI imaging findings were statistically analyzed according to Froberg standard. Results All 43 patients had subjective symptoms and some positive signs. 30 cases of X-ray changes were not obvious, of which 50% confirmed by CT examination ANFH Ⅰ; CT showed Ⅱ, Ⅲ, Ⅳ were more advanced than the X-ray diagnosis; MRI diagnosis of stage Ⅰ in 2 cases, CT was Ⅰ MRI was performed in 34 cases of stage Ⅱ, stage Ⅰ was CT, stage Ⅲ and stage Ⅳ of MRI were all diagnosed as late as stage 1 to 2 after CT. Conclusions X-ray photography is the basic test after hip injury caused by traffic injury, which has the prompt effect on further testing. CT scan is the first choice to judge ANFH and also the necessary data to guide the operation. MRI imaging is the best way to diagnose ANFH . In the road traffic disability assessment can be based on the need to choose the most appropriate means of inspection, and identification of time limit can be selected for a year or more than a year and a half.