Pouw Martin H, Deunk Jaap, Brink Monique, Dekker Helena M, Kool Digna R, van Vugt Arie B, Edwards Michael J R
Department of Surgery and Traumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Trauma. 2009 Nov;67(5):1027-32. doi: 10.1097/TA.0b013e31818cb261.
Discussion still remains which polytraumatized patients require radiologic thoracolumbar spine (TL spine) screening. The purpose of this study is to determine whether pelvic fractures are associated with TL spine fractures after a blunt trauma. Additionally, the sensitivity of conventional TL spine radiographs and pelvic radiographs (PXRs) is evaluated.
We prospectively studied 721 consecutive patients who had sustained a high-energy blunt trauma. The diagnostic workup in these patients included routine conventional radiographs of the pelvis and TL spine followed by a computed tomography (CT) analysis. All patients with pelvic fractures and TL spine fractures identified on conventional radiographs and CT were analyzed. A relative risk (RR) was calculated for the association between pelvic fractures and TL spine fractures. The sensitivity for conventional TL spine radiographs and PXRs in identifying fractures was calculated.
Of the 721 patients studied, 620 were included in our diagnostic high-energy trauma protocol. Of these 620 included patients, 86 (14%) suffered a pelvic fracture and 126 (20%) suffered a TL spine fracture. Thirty-three patients (5%) suffered both a pelvic fracture and a TL spine fracture. The RR for a TL spine fracture in the presence of a pelvic fracture identified on PXR is 2.14 (95% confidence interval, 1.54-2.98) and identified on CT this RR is 2.20 (95% confidence interval, 1.59-3.05). However, this association diminishes to a nonsignificant level when the transverse process and spinous process fractures are excluded. Overall sensitivity for conventional TL spine radiographs and PXRs is 22% and 69%, respectively.
Our data suggest that a pelvic fracture is not a predictor for clinically relevant TL spine fractures. Furthermore, our data confirm the superior sensitivity of CT for detecting TL spine injury and pelvic fractures.
对于哪些多发伤患者需要进行胸腰椎脊柱（TL脊柱）的放射学筛查，目前仍存在争议。本研究的目的是确定钝性创伤后骨盆骨折是否与TL脊柱骨折相关。此外，还评估了传统TL脊柱X线片和骨盆X线片（PXR）的敏感性。
我们前瞻性地研究了721例连续遭受高能钝性创伤的患者。这些患者的诊断检查包括骨盆和TL脊柱的常规X线片，随后进行计算机断层扫描（CT）分析。对所有在传统X线片和CT上发现骨盆骨折和TL脊柱骨折的患者进行分析。计算骨盆骨折与TL脊柱骨折之间关联的相对风险（RR）。计算传统TL脊柱X线片和PXR在识别骨折方面的敏感性。
在研究的721例患者中，620例纳入了我们的诊断性高能创伤方案。在这620例纳入的患者中，86例（14%）发生骨盆骨折，126例（20%）发生TL脊柱骨折。33例（5%）患者同时发生骨盆骨折和TL脊柱骨折。在PXR上发现骨盆骨折时，TL脊柱骨折的RR为2.14（95%置信区间，1.54 - 2.98），在CT上发现时，该RR为2.20（95%置信区间，1.59 - 3.05）。然而，当排除横突和棘突骨折时，这种关联减弱至无显著意义水平。传统TL脊柱X线片和PXR的总体敏感性分别为22%和69%。
我们的数据表明，骨盆骨折并非临床相关TL脊柱骨折的预测指标。此外，我们的数据证实了CT在检测TL脊柱损伤和骨盆骨折方面具有更高的敏感性。
