Demetriades D, Gomez H, Velmahos G C, Asensio J A, Murray J, Cornwell E E, Alo K, Berne T V
Department of Surgery, University of Southern California, Los Angeles 90033, USA.
Arch Surg. 1998 Oct;133(10):1084-8. doi: 10.1001/archsurg.133.10.1084.
The indications and method of evaluation of the mediastinum in blunt deceleration trauma are controversial and vary among centers. Most centers practice a policy of angiographic evaluation only in the presence of an abnormal mediastinum on chest radiography. Routine aortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successfully used in recent studies in the evaluation of the thoracic aorta.
To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injuries, irrespective of chest radiographic findings.
A prospective study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the head or abdomen. This group of patients underwent routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.
Large, urban, academic level I trauma center.
A total of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0%) with aortic rupture. Four (44.4%) of these patients had a normal mediastinum on the initial chest x-ray film and the diagnosis was made by CT scan. The CT scan was diagnostic in 8 of the aortic ruptures (intimal tear or pseudoaneurysm) and was suggestive of aortic injury but not diagnostic in 1 patient with brachiocephalic artery injury. In 42 patients (37.5%), there was a widened mediastinum: an aortic rupture was diagnosed in 5 of them (11.9%) and a spinal fracture in 9 (21.4%). One patient had both aortic rupture and spinal injury.
The incidence of aortic injury in patients with high-speed deceleration injury is high. A significant proportion of patients with aortic injury have a normal mediastinum on the initial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.
钝性减速伤中纵隔的评估指征和方法存在争议，各中心做法不一。大多数中心仅在胸部X线片显示纵隔异常时才进行血管造影评估。在无任何纵隔异常的情况下进行常规主动脉造影并未广泛应用。螺旋计算机断层扫描（CT）已成功用于近期胸主动脉评估的研究中。
确定常规螺旋CT扫描评估纵隔在高速减速伤患者中的作用，无论胸部X线检查结果如何。
为期1年的前瞻性研究。研究纳入了因高速减速伤需要进行头部或腹部CT评估的患者。这组患者无论胸部X线检查结果如何，均接受纵隔的常规螺旋CT评估。
大型城市一级学术创伤中心。
共有112例创伤患者符合研究纳入标准。总体而言，有9例（8.0%）患者发生主动脉破裂。其中4例（44.4%）患者初始胸部X线片纵隔正常，诊断由CT扫描做出。CT扫描对8例主动脉破裂（内膜撕裂或假性动脉瘤）具有诊断价值，对1例头臂动脉损伤患者提示有主动脉损伤但不能确诊。42例（37.5%）患者纵隔增宽：其中5例（11.9%）诊断为主动脉破裂，9例（21.4%）诊断为脊柱骨折。1例患者同时有主动脉破裂和脊柱损伤。
高速减速伤患者中主动脉损伤的发生率较高。相当一部分主动脉损伤患者初始胸部X线片纵隔正常。纵隔增宽时脊柱损伤的发生率较高。我们建议，所有具有高风险减速伤的创伤患者无论胸部X线检查结果如何，均应接受纵隔的常规螺旋CT评估。
