Frankel H L, Rozycki G S, Ochsner M G, Harviel J D, Champion H R
Department of Surgery, Washington Hospital Center, Washington, DC.
J Trauma. 1994 Oct;37(4):673-6. doi: 10.1097/00005373-199410000-00024.
The purpose of this study was to identify risk factors for thoracic/lumbar spine fractures in patients with blunt injuries and subsequently establish indications for obtaining surveillance thoracolumbar radiographs. Retrospective review of all patients with blunt injuries (n = 1485) admitted in 1992 to a level I trauma center with a discharge diagnosis of thoracolumbar spine fracture established entrance criteria for a 4-month prospective study. Relative risk of fracture (RR) was calculated. Retrospective. Seventy-six percent (176 of 233) had radiographs; 21% had fractures; one diagnosed late. Prospective. One hundred percent (167 of 167) had radiographs; 9% (15 of 167) had fractures; none diagnosed late or missed. Forty percent (26 of 65) of patients with fractures had no pain or tenderness; 35% (9) required surgical spinal fixation. Our data define these indications for obtaining thoracolumbar radiographs in patients with blunt injuries: back pain (RR1), fall > or = 10 feet, ejection from motorcycle/motor vehicle crash > or = 50 mph, GCS score < or = 8, (all RR2), and neurologic deficit (RR10). The sensitivity of our surveillance radiography protocol has increased to 100%. The absence of back pain does not exclude significant thoracolumbar trauma.
本研究的目的是确定钝性损伤患者胸腰椎骨折的危险因素，并随后确定进行胸腰椎X线片监测的指征。对1992年入住一级创伤中心、出院诊断为胸腰椎骨折的所有钝性损伤患者（n = 1485）进行回顾性分析，确定了一项为期4个月的前瞻性研究的入选标准。计算骨折的相对风险（RR）。回顾性研究。76%（233例中的176例）进行了X线检查；21%发生骨折；1例诊断较晚。前瞻性研究。100%（167例中的167例）进行了X线检查；9%（167例中的15例）发生骨折；无诊断较晚或漏诊的情况。40%（65例中的26例）骨折患者无疼痛或压痛；35%（9例）需要进行脊柱手术固定。我们的数据确定了钝性损伤患者进行胸腰椎X线检查的指征：背痛（RR1）、坠落≥10英尺、从摩托车/机动车碰撞中以≥50英里/小时的速度弹出、格拉斯哥昏迷评分≤8分（均为RR2）以及神经功能缺损（RR10）。我们的监测X线检查方案的敏感性已提高到100%。无背痛并不能排除严重的胸腰椎创伤。
