VAI TRÒ CỦA CHỤP CẮT LỚP ĐIỆN TOÁN NGỰC TRONG CHẨN ĐOÁN GÃY XƯƠNG SƯỜN DO CHẤN THƯƠNG CÓ MẢNG SƯỜN DI ĐỘNG

Abstract

Introduction: Globally, trauma accounts for more than 5 million deaths annually, representing approximately 9% of all-cause mortality. Thoracic trauma constitutes around 10% of all hospitalized traumatic injuries but is responsible for 25–50% of trauma-related deaths. Among thoracic injuries, rib fractures are the most common, occurring in approximately 10% of patients admitted with blunt chest trauma. Rib fractures may become life-threatening, particularly in elderly patients, those with pre-existing pulmonary disease, or in cases complicated by flail chest. From a diagnostic imaging perspective, the two primary modalities employed are plain chest radiography and multidetector computed tomography (MDCT) with three-dimensional rib reconstruction. While chest MDCT provides comprehensive information on both rib fractures and associated intrathoracic injuries, there remains a paucity of studies specifically evaluating its role in the diagnosis of traumatic rib fractures associated with flail chest. Objective: To evaluate the role of chest computed tomography (CT) in the diagnosis of rib fractures caused by blunt thoracic trauma, particularly in cases involving flail chest. Methods: A prospective descriptive study was conducted on 40 patients with chest trauma who underwent CT imaging at Cho Ray Hospital from January 2018 to February 2021. Clinical features, CT findings, operative data, and associated complications were analyzed. The diagnostic sensitivity of CT was compared with conventional chest radiography (CXR). Results: Chest CT detected 36.9% more rib fractures compared to CXR (mean 5.6 vs. 3.1 fractures per patient, p<0.001). CT identified all cases of flail chest (100%), while CXR detected only 64.7%. In addition, CT revealed associated injuries including hemothorax/pneumothorax (84.7%), pulmonary contusions (62.3%), cardiac injuries (4.2%), and great vessel injuries (2.1%). CT provided detailed anatomical information for surgical planning and early intervention. Conclusion: Chest CT is superior to plain radiography in diagnosing rib fractures and flail chest. It plays a critical role in detecting associated intrathoracic injuries and guiding timely and accurate treatment strategies.