Blacksin M F, Lee H J
Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103-2426, USA.
AJR Am J Roentgenol. 1995 Nov;165(5):1201-4. doi: 10.2214/ajr.165.5.7572503.
Radiographic evaluation of the upper cervical spine in patients who have suffered severe trauma is often problematic because of the difficulty of obtaining adequate open-mouth views of the odontoid in these critically ill patients. This study was undertaken to determine the frequency and clinical significance of upper cervical spine fractures detected by CT in this patient population.
The study group consisted of 100 consecutive patients brought to the emergency department after severe trauma who had CT of the craniocervical junction done instead of an open-mouth view. Plain film evaluation consisted of a cross-table lateral view, an anteroposterior view, and, if necessary, a swimmer's view. The radiographic studies were reviewed retrospectively by a musculoskeletal radiologist and a neuroradiologist, respectively. Hospital records were reviewed to ascertain the patients' clinical signs and symptoms on admittance and to determine how identification of the fractures changed the treatment plan.
Eight fractures in seven patients were identified with CT of the craniocervical junction. Three of the fractures were of the occipital condyle, and five were at the C1-C2 level. None of the fractures were seen directly on plain radiographs, although secondary signs of injury such as prevertebral soft-tissue swelling were seen in two of the seven cases.
CT of the craniocervical junction revealed an 8% frequency of fractures of the occipital condyle and C1-C2 that were undetected on the cross-table lateral cervical spine radiographs. Fractures occurred in greater numbers than expected, and all surviving patients were stabilized with a halo. This experience shows that CT is an efficient method of evaluating patients in whom the standard open-mouth radiograph of the odontoid cannot be done.
对于遭受严重创伤的患者，其上颈椎的影像学评估常常存在问题，因为在这些危重病患者中难以获得足够的齿状突开口位片。本研究旨在确定在这一患者群体中通过CT检测到的上颈椎骨折的发生率及临床意义。
研究组由100例连续的严重创伤后被送至急诊科的患者组成，这些患者接受了颅颈交界区CT检查而非开口位片检查。平片评估包括颈椎侧位片、前后位片，必要时还包括游泳者位片。影像学研究分别由一位肌肉骨骼放射科医生和一位神经放射科医生进行回顾性审查。查阅医院记录以确定患者入院时的临床体征和症状，并确定骨折的识别如何改变治疗方案。
通过颅颈交界区CT在7例患者中发现了8处骨折。其中3处骨折位于枕髁，5处位于C1-C2水平。尽管在7例中有2例可见椎前软组织肿胀等损伤间接征象，但在平片上均未直接发现骨折。
颅颈交界区CT显示枕髁和C1-C2骨折的发生率为8%，这些骨折在颈椎侧位平片上未被发现。骨折数量多于预期，所有存活患者均通过头环固定实现了稳定。这一经验表明，CT是评估无法进行标准齿状突开口位X线片检查患者的有效方法。
