Paakkala T, Keski-Nisula L, Lehtinen E
Rofo. 1978 May;128(5):550-8. doi: 10.1055/s-0029-1230902.
The frequency of fractures of the cervical spine has increased with the rise in traffic accidents, but the radiological diagnosis of fractures at the initial examination remains unsatisfactory. A false negative diagnosis in the accident department was made in 25 out of 86 patients (29%) by a surgeon and in 12 patients (14%) by a radiologist. Poor radiographic quality was an important source of error, particularly for the diffult fractures in the cranial and caudal parts of the cervical spine. Half the fractures of the arch of the atlas and of the odontoid were missed initially. There was also difficulty in diagnosing fractures of the articular processes, evulsion fractures of the vertebrae and unilateral subluxation. Since the late results of missed vertebral fractures may be fatal, it is necessary to make more use of those signs which may indicate a fracture. Widening of the pre-vertebral soft tissues was seen in 33 out of 100 patients and an increased distance between articular facets on the A. P. projection in 19 out of 100 patients. Angled A. P. projections are useful for the diagnosis of fractures of articular facets in bed-ridden patients. Fractures in the lower cervical spine are well seen on oblique supine views. In larger accident departments, tomography and immediate radiological consultation should be available.
随着交通事故的增加，颈椎骨折的发生率也在上升，但初次检查时骨折的放射学诊断仍不尽人意。在事故科室，外科医生对86例患者中的25例（29%）做出了假阴性诊断，放射科医生对12例患者（14%）做出了假阴性诊断。X线片质量差是一个重要的误差来源，尤其是对于颈椎颅部和尾部的复杂骨折。最初漏诊了一半的寰椎弓和齿状突骨折。诊断关节突骨折、椎体撕脱骨折和单侧半脱位也存在困难。由于漏诊椎体骨折的后期后果可能是致命的，因此有必要更多地利用那些可能提示骨折的体征。100例患者中有33例可见椎前软组织增宽，100例患者中有19例在前后位投照时关节面间距增加。倾斜前后位投照对诊断卧床患者的关节突骨折很有用。颈椎下部骨折在仰卧斜位片上显示良好。在较大的事故科室，应提供体层摄影和即时放射学会诊。
