Moch A L, Schweitzer M E, Parker L
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Skeletal Radiol. 2000 Jun;29(6):340-5. doi: 10.1007/s002560000197.
Prevertebral soft tissue swelling (PVSTS) is an important marker of spinal trauma. In patients with missed or occult cervical fractures, it may be the only indication of serious injury. It has been anecdotally suggested that PVSTS is not useful following placement of a nasogastric (NGT) or endotracheal (ETT) tube because of possible iatrogenic trauma and/or soft tissue compression. Consequently, we investigated trauma patients for evidence of PVSTS, comparing radiographs performed before and after placement of NGTs and/or ETTs.
PVSTS at the C2 and C6 levels was measured on lateral cervical spine radiographs in 102 patients with cervical spine fractures. Measurements were obtained in 66 patients before and after placement of either an NGT (23), ETT (8), or both an NGT and ETT (35). They were also obtained in 36 control patients with fractures and neither an NGT nor ETT, at presentation and after an interval temporally matched to that in the patients with tubes in place.
The group with ETTs showed variable changes to PVSTS (31% increase, 63% decrease, and 6% no change). The group with NGTs also showed variable changes to PVSTS (33% increase, 53% decrease, and 13% no change). The group with ETTs and NGTs similarly showed variable changes to PVSTS (25% increase, 72% decrease, 3% no change). Surprisingly, the control group showed similar temporal changes without tube placement (49% increase, 36% decrease, 13% no change). Analyses using the one-tailed F-test of the ratio of the variance of the tube to non-tube groups and the Mann-Whitney test were performed. No significant difference was found in the prevertebral soft tissues at the C2 level between those with tubes in place and the control subjects. However, at the C6 level there was statistical significance between the groups with NGTs and both NGTs and ETTs versus the non-tube groups. Probability under the F-test for the groups with NGTs and both NGTs and ETTs was 0.001 and 0.005, respectively. Under the Mann-Whitney test, P values for groups with NGTs and both NGTs and ETTs were 0.0002 and 0.0001, respectively.
The appearance of PVSTS showed variable and unpredictable changes following ETT, NGT, or combined ETT/NGT placement at the C2 level. This appears to be an artifact of temporal changes. However, at the C6 level, the presence of PVSTS following NGT or ETT and NGT placement (but not ETT placement alone) may be an accurate indirect sign of cervical spine injury.
椎前软组织肿胀（PVSTS）是脊柱创伤的一个重要标志。在漏诊或隐匿性颈椎骨折患者中，它可能是严重损伤的唯一指征。有传闻称，由于可能的医源性创伤和/或软组织压迫，放置鼻胃管（NGT）或气管内插管（ETT）后PVSTS就没有用了。因此，我们对创伤患者进行了PVSTS证据的调查，比较了放置NGT和/或ETT前后所拍摄的X线片。
对102例颈椎骨折患者的颈椎侧位X线片测量C2和C6水平的PVSTS。在66例患者中进行了测量，这些患者分别放置了NGT（23例）、ETT（8例）或同时放置了NGT和ETT（35例）。还对36例骨折且既未放置NGT也未放置ETT的对照患者进行了测量，测量时间为就诊时以及与放置管道患者时间间隔相匹配的一段时间后。
放置ETT的组PVSTS变化不一（增加31%，减少63%，无变化6%）。放置NGT的组PVSTS同样变化不一（增加33%，减少53%，无变化13%）。同时放置ETT和NGT的组PVSTS也变化不一（增加25%，减少72%，无变化3%）。令人惊讶的是，未放置管道的对照组也出现了类似的时间变化（增加49%，减少36%，无变化13%）。使用单尾F检验分析了放置管道组与未放置管道组的方差比，并进行了曼-惠特尼检验。放置管道的患者与对照受试者在C2水平的椎前软组织上未发现显著差异。然而，在C6水平，放置NGT组以及同时放置NGT和ETT组与未放置管道组之间存在统计学差异。放置NGT组以及同时放置NGT和ETT组的F检验概率分别为0.001和0.005。在曼-惠特尼检验中，放置NGT组以及同时放置NGT和ETT组的P值分别为0.0002和0.0001。
在C2水平放置ETT、NGT或联合放置ETT/NGT后，PVSTS的表现变化不定且不可预测。这似乎是时间变化导致的假象。然而，在C6水平，放置NGT或同时放置ETT和NGT（但单独放置ETT时不会）后出现PVSTS可能是颈椎损伤的一个准确间接征象。
