Barba C A, Taggert J, Morgan A S, Guerra J, Bernstein B, Lorenzo M, Gershon A, Epstein N
Department of Surgery, Saint Francis Hospital and Medical Center, University of Connecticut, Hartford, Connecticut 06105, USA.
J Trauma. 2001 Oct;51(4):652-6; discussion 656-7. doi: 10.1097/00005373-200110000-00005.
The purpose of this study was to assess a cervical spine clearance protocol for blunt trauma patients using helical computed tomographic (CT) scan of the cervical spine (C-spine).
A protocol using CT scan of the C-spine was implemented and the first 6 months of use reviewed. Patients requiring a CT scan of the head had the C-spine evaluated by lateral C-spine radiography and a helical CT scan. Patients without indication for CT scan of the head had the C-spine evaluated by three-view radiography (anteroposterior, lateral, and odontoid) with selective CT scan of the C-spine for imaging areas not well visualized or those with abnormalities identified by radiography or by clinical examination alone.
Three hundred twenty-four patients were admitted to the trauma center after blunt trauma during the first 6 months of protocol implementation. Head CT scans were obtained in 158 patients and lateral cervical spine radiography in conjunction with helical CT scanning evaluated the C-spine. The other 166 patients had the cervical spine cleared by three-view radiography series or by clinical examination alone. For patients in whom a head CT scan was not indicated, CT scanning was used only when plain radiographs failed to adequately visualize the entire C-spine. A total of 15 injuries (4.6% of the group) were detected. Seven injuries were suspected or detected by lateral plain radiographs and confirmed by CT scan. Six patients had an injury not detected by radiography but diagnosed by CT scan, and one patient had a false-positive radiograph. Of the remaining two injuries, one was diagnosed by magnetic resonance imaging and the other by CT scan outside of the protocol. Lateral plain radiographs alone failed to detect 46% (n = 6) of all injuries.
In our series, the selective use of helical CT scanning with plain radiography increased the accuracy with which cervical spine injury was detected from 54% to 100%. The protocol allowed for more rapid evaluation in many patients as well. We recommend that practice guidelines include the use of helical CT scan of the entire C-spine as the diagnostic procedure for those blunt trauma patients undergoing CT scanning of the head.
本研究旨在评估一项针对钝性创伤患者的颈椎评估方案，该方案使用颈椎螺旋计算机断层扫描（CT）。
实施一项使用颈椎CT扫描的方案，并对其使用的前6个月进行回顾。需要进行头部CT扫描的患者，其颈椎通过颈椎侧位X线片和螺旋CT扫描进行评估。无头部CT扫描指征的患者，其颈椎通过正位、侧位和齿状突三位X线片进行评估，并对X线片显示不佳或仅通过X线片或临床检查发现异常的部位进行选择性颈椎CT扫描。
在方案实施的前6个月，共有324例钝性创伤患者被收入创伤中心。158例患者进行了头部CT扫描，并通过颈椎侧位X线片联合螺旋CT扫描对颈椎进行评估。另外166例患者的颈椎通过三位X线片系列或仅通过临床检查得以排除。对于未进行头部CT扫描指征的患者，仅在平片未能充分显示整个颈椎时才使用CT扫描。共检测到15处损伤（占该组的4.6%）。7处损伤通过侧位平片怀疑或检测到，并经CT扫描证实。6例患者的损伤未被X线片检测到，但经CT扫描诊断，1例患者的X线片为假阳性。在其余2处损伤中，1例通过磁共振成像诊断，另1例在方案外通过CT扫描诊断。仅侧位平片未能检测到所有损伤的46%（n = 6）。
在我们的系列研究中，螺旋CT扫描与平片的选择性使用将颈椎损伤的检测准确率从54%提高到了100%。该方案还使许多患者能够更快地得到评估。我们建议实践指南应包括将整个颈椎的螺旋CT扫描作为对那些接受头部CT扫描的钝性创伤患者的诊断方法。
