Nemsadze G, Lapiashvili E, Urushadze O, Gotsadze G
University Central Clinical Hospital after N. Kipshidze, Tbilisi, Georgia.
Georgian Med News. 2011 Nov;11(200):42-51.
Spinal injury in poly trauma patients is serious problem, because they cause high mortality and morbidity. According to WHO statistics, there are registered 30 million cases of spinal injuries annually, 50% of them die before reaching the hospital. In last 5 years incidence of spinal traumas has increased 2.6 fold and is about one third of all spinal diseases. That is why spinal injuries remain a challenge. The purpose of our study is to assess diagnostic efficiency of multislice spiral CT in diagnosis of spinal injuries in poly trauma patients. We randomly assessed data from 200 poly trauma patients, who underwent multislice spiral CT in poly trauma mode. In 92 (46%) patients different types of spinal fractures and injuries were detected. Age distribution was 16-72 (mean age 52 years). Out of 92 patients, 9 (4.5%) had isolated trauma, 83 (41.5%) had multiple trauma. Solitary injury of spinal column was detected in 30 (32.6%) patients, 54 (58.6%) had combined spinal injuries. In spinal injury patients the most common trauma mechanism was MVC - 56 patients (60.86%), fall from height 27 (29.36%) patients, diving 5 (5.43%) patients, gun shot wound 3 (3.26%) patients, industrial injury 1 (1.08%) patients. The most common location of the injury was lumbar vertebra (55 patients), thoracic vertebra (39 patients), cervical vertebra (28 patients). After assessing MDCT and MRI results 37 patients were operated, 6 of them underwent surgical intervention urgently, 31 had delayed surgery, that was performed after treating other life threatening injuries. Indications for surgical intervention were spinal cord compression and non stable vertebral fractures. According to our study results, MDCT is the study of choice for the diagnosis of spinal injuries in poly trauma patients. It helps to detect type and extension of the bony injury and visualize fragments in the spinal canal. It is superior to other radiological studies. 3D, MIP and MPR reconstruction gives information about spatial location of the fracture and helps to timely plan correct management.
多发伤患者的脊柱损伤是一个严重问题，因为它们会导致高死亡率和高发病率。根据世界卫生组织的统计，每年登记有3000万例脊柱损伤病例，其中50%在到达医院之前死亡。在过去5年中，脊柱创伤的发病率增加了2.6倍，约占所有脊柱疾病的三分之一。这就是为什么脊柱损伤仍然是一个挑战。我们研究的目的是评估多层螺旋CT在多发伤患者脊柱损伤诊断中的诊断效率。我们随机评估了200例接受多层螺旋CT多发伤模式检查的多发伤患者的数据。在92例（46%）患者中检测到不同类型的脊柱骨折和损伤。年龄分布为16 - 72岁（平均年龄52岁）。在92例患者中，9例（4.5%）为单纯伤，83例（41.5%）为多发伤。30例（32.6%）患者检测到脊柱单独损伤，54例（58.6%）为合并脊柱损伤。在脊柱损伤患者中，最常见的创伤机制是机动车碰撞——56例患者（60.86%），高处坠落27例（29.36%）患者，潜水5例（5.43%）患者，枪伤3例（3.26%）患者，工伤1例（1.08%）患者。损伤最常见的部位是腰椎（55例患者）、胸椎（39例患者）、颈椎（28例患者）。在评估多层螺旋CT和磁共振成像结果后，37例患者接受了手术，其中6例紧急接受了手术干预，31例接受了延迟手术，延迟手术是在治疗其他危及生命的损伤之后进行的。手术干预的指征是脊髓受压和不稳定椎体骨折。根据我们的研究结果，多层螺旋CT是多发伤患者脊柱损伤诊断的首选检查方法。它有助于检测骨损伤的类型和范围，并显示椎管内的碎骨片。它优于其他放射学检查。三维、最大密度投影和多平面重建可提供骨折空间位置的信息，并有助于及时制定正确的治疗方案。
