Schuster Rob, Waxman Kenneth, Sanchez Barry, Becerra Salvador, Chung Richard, Conner Scott, Jones Thomas
Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA 93102, USA.
Arch Surg. 2005 Aug;140(8):762-6. doi: 10.1001/archsurg.140.8.762.
Trauma patients with normal motor examination results and normal cervical spine helical computed tomographic (CT) scans with sagittal reconstructions do not have significant cervical spine injury.
Prospectively collected registry data.
Level II community-based trauma center.
All patients admitted to the trauma service from January 1, 1999, to December 31, 2003.
Injury detected by CT and/or magnetic resonance imaging (MRI) of the cervical spine. Neurologic examination and need for surgery were secondary outcomes.
During the study period, 2854 trauma patients were admitted, of whom 91.2% had blunt trauma. Of these patients, 56.2% had a closed head injury. One hundred patients had cervical spine and/or spinal cord injuries. Eighty-five patients had a cervical spine injury diagnosed by CT. Fifteen patients had admission neurologic deficits not seen on CT, and 7 of these patients had non-bony abnormalities on MRI. Ninety-three patients had a normal admission motor examination result, a CT result negative for trauma, and persistent cervical spine pain, and were examined with MRI. All MRI examination results were negative for clinically significant injury. Seventeen patients had MRIs that showed degenerative disc disease, and 6 had spinal canal stenosis secondary to ossification. Twelve comatose patients (Glasgow Coma Scale score, <9), moving all 4 extremities on arrival, with normal CT results of the cervical spine, were examined with MRI. All of these MRI examination results were negative for injury. None of the patients experienced neurologic deterioration. No patient required operative management of spinal injury.
Blunt trauma patients with normal motor examination results and normal CT results of the cervical spine do not require further radiologic examination before clearing the cervical spine.
运动检查结果正常且颈椎螺旋计算机断层扫描（CT）矢状面重建正常的创伤患者不存在明显的颈椎损伤。
前瞻性收集登记数据。
二级社区创伤中心。
1999年1月1日至2003年12月31日期间入住创伤科的所有患者。
颈椎CT和/或磁共振成像（MRI）检测到的损伤。神经学检查和手术需求为次要观察指标。
在研究期间，共收治2854例创伤患者，其中91.2%为钝性创伤。这些患者中，56.2%有闭合性颅脑损伤。100例患者有颈椎和/或脊髓损伤。85例患者经CT诊断为颈椎损伤。15例患者入院时存在CT未显示的神经功能缺损，其中7例患者MRI显示非骨性异常。93例患者入院时运动检查结果正常、CT检查创伤结果为阴性但持续存在颈椎疼痛，接受了MRI检查。所有MRI检查结果均未显示有临床意义的损伤。17例患者的MRI显示椎间盘退变，6例患者因骨化继发椎管狭窄。12例昏迷患者（格拉斯哥昏迷量表评分<9）入院时四肢均能活动且颈椎CT结果正常，接受了MRI检查。所有这些MRI检查结果均未显示有损伤。所有患者均未出现神经功能恶化。无一例患者需要接受脊柱损伤的手术治疗。
运动检查结果正常且颈椎CT结果正常的钝性创伤患者在排除颈椎损伤前无需进一步的影像学检查。
