Imageological Diagnosis Of Pelvic Fracture And Pelvis Multiple Organ Injuries

Objective:To Compare the imaging findings of pelvic fracture between x-ray and CT scan, and evaluate the value of the retrograde urethrography in the diagnosis of merge pelvic organ injuries.Material and methods:The imaging findings of 620 cases of pelvic fracture which have full image data were analyzed.369 cases were males,251 cases were females, the mean age is 42.6 years old. All cases were accepted x-ray and CT scan. The cases suspected acetabular or sacral fracture carried out thin slice CT scanning of hip or sacrum.58 cases which suspected urethral or bladder injury were carried out retrograde urethragraphy pre-operatively. Then 5 cases were carried out spiral CT scanning. There were 98 patients who had follow-up regularly.Results:There were 1036 fractures in quantity and 38 dearticulation of 620 cases. 255 iliac fractures,226 acetabular fractures,99 sacral and coccyx fractures,341 pubic upper and lower branches fractures,115 ischia fratures,20 cases of dislocation of hip joint and sacroiliac joint. About 169 micro-fractures,1 post dislocation of hip joint,5 mild dislocations of sacroiliac joint and 3 mild separation of pubic symphysis were mis-diagnosed by X-ray. Fracture and dislocation detection rates of X-ray plain film is 83.4%. Among 226 acetabular fractures, x-ray plain film and SSD mis-diagnosed about 61 and 20 fractures separately. The detection rate of x-ray plain film and SSD of fracture-dislocation was 73.0% and 91.2%. In 99 sacral and coccyx fractures, x-ray plain film and SSD mis-diagnosed about 43 and 13 cases, the fracture-dislocation detection rate was 56.0% and 89.9% separately.620 pelvic fractures and 178 acetabular fractures were divided on the basis of Tile and AO grouping. Through x2 examination, x-ray plain film and CT had differences in statistically(P<0.05). There's no statistical difference between SCT/MPR and SSD (P>0.05). Among 58 cases of pre-operative retrograde urethrography,19 cases were posterior urethral disruption,39 cases were bladder rupture. Follow up of 34 cases post-operative demonstrated 11 cases had invarying degrees of urethral stricture,4 cases had posterior urethra occlusion,1 case had posterior urethra rupture and dislocation,17 cases were urethral patency with no narrow or interrupted. Follow up of 64 cases of bladder rupture, there were not leakage of contrast agent. There was a significant difference between traffic accident and fall from high places in incidence of pelvic fracture. In traffic accident, the incidence of fracture and dislocation in left pelvic side was more than right. The incidence of iliac fracture, acetabular fracture and pubic symphysis separation in traffic accident was more than falling from high places. But the incidence of sacral fracture, coccyx fracture and ischia frature was less of the latter. The incidence of pubic upper and lower branches fracture and dislocation of hip joint, sacroiliac joint was similar between these two groups.Conclusion:The detection rate of pelvic fracture with spiral CT is better than X-ray Plain film. Through MPR and SSD of spiral CT, the fracture and its surrounding strutures is displayed well, providing the guidance for correct preoperative diagnosis, treatment options, surgical approach and to develop detailed operation plan. The retrograde urethrography is a reliable method for urethral or bladder injury preoperatively. It also provides a useful help for evaluation patency level of urinary tract or whether leakage postoperatively. After injected contrast medium, Spiral CT scan can display bladder rupture and contrast medium geographical distribution in pelvis. This study demonstrates that there exists a change in the patterns and severity of the injury because the causes of injury are different. There is a significant difference between traffic accident and falling from high places in incidence of pelvic fracture.