Jelly L M, Evans D R, Easty M J, Coats T J, Chan O
Department of Radiology, The Royal London Hospital, Whitechapel, London E1 1BB, England.
Radiographics. 2000 Oct;20 Spec No:S251-9; discussion S260-2. doi: 10.1148/radiographics.20.suppl_1.g00oc20s251.
A prospective study was performed over a 1-year period in patients who had sustained blunt trauma, mostly in motor vehicle accidents. All 73 patients (56 male and 17 female; age range, 2-94 years; mean age, 35.2 years) in the study had undergone intubation and ventilation at the trauma site (mean Glasgow Coma Score, 9.9 [range, 3-15]; mean Injury Severity Score, 30.4 [range, 8-75]) and subsequently underwent three-view radiography of the cervical spine and thin-section spiral computed tomography (CT) of the cervicothoracic junction. Spinal fractures were detected in 20 patients and involved the cervicothoracic junction region in 12 cases. In all 12 patients, the fractures were visualized at CT, whereas in seven of 12 patients, conventional radiography failed to demonstrate injuries (transverse process fracture of T1 [n = 1], pedicle and vertebral body fracture of C7 [n = 1], fractures of the first and second ribs [n = 5]). Thus, routine CT of the cervicothoracic junction in a highly select group of severely injured patients helped detect occult fracture in seven of 73 patients (10%); however, most of these fractures were not clinically significant. Larger studies involving a high-risk patient population are needed to confirm these findings.
在1年的时间里，我们对主要因机动车事故而遭受钝性创伤的患者进行了一项前瞻性研究。该研究中的所有73例患者（56例男性和17例女性；年龄范围为2至94岁；平均年龄为35.2岁）均在创伤现场接受了插管和通气治疗（格拉斯哥昏迷评分平均为9.9[范围为3至15]；损伤严重程度评分平均为30.4[范围为8至75]），随后接受了颈椎的三位X线摄影以及颈胸交界处的薄层螺旋计算机断层扫描（CT）。20例患者检测到脊柱骨折，其中12例累及颈胸交界区。在所有12例患者中，骨折在CT上均可见，而在12例患者中的7例中，传统X线摄影未能显示损伤（T1横突骨折[n = 1]，C7椎弓根和椎体骨折[n = 1]，第1和第2肋骨骨折[n = 5]）。因此，在一组经过严格筛选的重伤患者中，对颈胸交界处进行常规CT检查有助于在73例患者中的7例（10%）检测到隐匿性骨折；然而，这些骨折大多数在临床上并不重要。需要开展涉及高危患者群体的更大规模研究来证实这些发现。
