Sobus K M, Alexander M A, Harcke H T
Alfred I. duPont Institute, Wilmington, DE 19899.
Arch Phys Med Rehabil. 1993 Sep;74(9):902-4.
A prospective study of 82 traumatically injured patients was conducted to determine the frequency with which skeletal trauma was undetected at acute care facilities. The clinical significance of each instance of undetected trauma on the patient's rehabilitation programs was assessed. Between May 1987 and October 1988, all trauma patients who sustained a spinal cord injury (SCI) or a severe traumatic brain injury (TBI) had total body bone scans (Tc-99mMDP) prior to beginning rehabilitation. These patients were unable to indicate pain secondary to absent sensation or cognitive impairment. In 60 children with TBI, 16 had a total of 25 newly detected fracture sites and 19 had 24 newly detected areas of soft tissue trauma. In 12 children the findings were clinically significant in that they led to behavior problems or impeded therapy. Although three new fracture sites and six soft tissue trauma sites were detected in seven children with SCI, none were clinically significant. Additionally, heterotopic ossification was detected in 14 children, of which only two sites were previously known. In three children with TBI, the area of heterotopic ossification impeded functional range of motion. Based upon this data we conclude that a total body bone scan is useful in the child with TBI for the detection of undiagnosed skeletal or soft tissue trauma and heterotopic ossification not recognized during acute care.
对82例创伤患者进行了一项前瞻性研究，以确定急性护理机构中骨骼创伤未被检测到的频率。评估了每例未被检测到的创伤对患者康复计划的临床意义。在1987年5月至1988年10月期间，所有脊髓损伤（SCI）或严重创伤性脑损伤（TBI）的创伤患者在开始康复之前都进行了全身骨扫描（Tc-99m MDP）。这些患者因感觉缺失或认知障碍无法指出疼痛。在60例TBI儿童中，16例共有25个新发现的骨折部位，19例有24个新发现的软组织创伤区域。在12例儿童中，这些发现具有临床意义，因为它们导致了行为问题或妨碍了治疗。虽然在7例SCI儿童中检测到3个新的骨折部位和6个软组织创伤部位，但均无临床意义。此外，在14例儿童中检测到异位骨化，其中只有2个部位是先前已知的。在3例TBI儿童中，异位骨化区域妨碍了功能活动范围。基于这些数据，我们得出结论，全身骨扫描对TBI儿童检测急性护理期间未诊断出的骨骼或软组织创伤以及未识别的异位骨化是有用的。
