Spiteri Veronique, Kotnis Rohit, Singh Parminder, Elzein Rihab, Madhu Rachala, Brooks Adam, Willett Keith
Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom.
J Trauma. 2006 Nov;61(5):1171-7; discussion 1177. doi: 10.1097/01.ta.0000236000.95954.9a.
The safest and most effective method of early cervical spine clearance in unconscious patients is the subject of intense debate. We hypothesize that helical computed tomography (CT) is a sufficiently sensitive investigation to render dynamic screening redundant.
We retrospectively reviewed the records of 839 trauma patients admitted to the intensive care unit under the orthopedic surgeons from April 1994 to September 2004. Our protocol for cervical spinal clearance in the unconscious patient involves plain radiographs, CT scanning, and dynamic screening. We recorded the presence of any unstable cervical spine injury and any cases that were missed by CT but detected by dynamic screening.
There were 87 patients with an unstable cervical spine. Of these, 85 were detected by CT. Two cases were missed by CT (sensitivity 97.7%, specificity 100%). In one of these patients, dynamic screening detected an unstable spine and in the other patient dynamic screening missed an atlanto-occipital dislocation (sensitivity 98.8%, specificity 100%). Critical analysis of this case revealed that a powers ratio calculation on the CT scan would have detected the injury. There were no complications as a result of dynamic screening.
Dynamic screening is a safe procedure but has no real advantage over helical CT. Power's ratio calculation is essential to reduce the chance of a missing an upper cervical injury. The cervical spine can be reliably cleared using helical CT alone.
在无意识患者中进行早期颈椎评估的最安全、最有效的方法是激烈争论的主题。我们假设螺旋计算机断层扫描（CT）是一种足够敏感的检查，使得动态筛查变得多余。
我们回顾性分析了1994年4月至2004年9月间在骨科医生管理下入住重症监护病房的839例创伤患者的记录。我们对无意识患者进行颈椎评估的方案包括X线平片、CT扫描和动态筛查。我们记录了任何不稳定颈椎损伤的存在情况以及任何CT漏诊但通过动态筛查发现的病例。
有87例患者存在不稳定颈椎损伤。其中，85例通过CT检测到。2例被CT漏诊（敏感性97.7%，特异性100%）。在其中1例患者中，动态筛查检测到不稳定脊柱，而在另1例患者中，动态筛查漏诊了寰枕关节脱位（敏感性98.8%，特异性100%）。对该病例的批判性分析表明，在CT扫描上进行鲍尔斯比率计算本可检测到该损伤。动态筛查未导致任何并发症。
动态筛查是一种安全的检查，但相对于螺旋CT并无实际优势。鲍尔斯比率计算对于减少漏诊上颈椎损伤的可能性至关重要。仅使用螺旋CT就能可靠地完成颈椎评估。
