上颈椎损伤的放射征象特点与预后指导
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摘要
目的观察上颈椎损伤典型患者的螺旋CT三维成像检查征象之间存在的差异,为患者预后情况提高临床指导分析。方法选取衢州市柯城区人民医院2014年6月—2015年1月就诊的寰椎损伤患者75例作为研究对象,在患者治疗前后分别进行X线、螺旋CT三维成像2种检查方式,通过对比患者治疗前后影像学检查结果,分析出患者应用X线检查与螺旋CT三维成像检查结果的差异,并结合患者预后情况进行总结,对比患者治疗前后颈椎损伤的形态学改变、患者预后情况。结果经X线检查,骨折移位<3 mm、成角畸形、过伸+垂直暴力3个方面正确率分别为26.67%、50.67%、16.00%,均低于螺旋CT检查的3个方面正确率(42.67%、66.67%、42.67%,均P<0.05);螺旋CT三维成像技术的正确诊断率(100.00%)显著高于X线检查的正确诊断率(80.00%,P<0.05);预后不良与误诊或漏诊间存在相关性(P<0.05)。结论对于上颈椎损伤患者经X线检查容易出现误诊及漏诊情况,对于骨折移位<3 mm、成角畸形、过伸+垂直暴力等解剖结构或损伤部位不易分辨的患者,可以进一步进行螺旋CT三维成像检查,能够提高患者诊断的正确率,有助于避免预后不良情况的发生,临床中2种影像学检查的合理选用有助于患者预后的改善。
Objective To observe the differences in radiological signs of cervical spine CT and X-ray in patients with upper cervical spine injury,and provide guidance for prognosis analysis. Methods The patients with atlas injury in our hospital from June,2014 to January,2015 were selected. X-ray and CT were performed in all patients before and after the treatment. To compare the difference in the morphologic changes of the injured cervical spine between X-ray and CT combined with the prognosis of patients. Results The accuracy rate of X-ray for fracture displacement less than 3 mm,angulation deformity,hyperextension injuries and vertical compression injury of violence was 26. 67%,50. 67% and16. 00%,respectively,which was lower than 42. 67%,66. 67%,42. 67% of CT( P < 0. 05); The correct diagnostic rate of spiral CT three-dimensional imaging technology was significantly higher than X-ray( 100. 00% vs. 80. 00%,P <0. 05); The poor prognosis of patients was correlated with the misdiagnosis or missed diagnosis( P < 0. 05).Conclusion The misdiagnosis and missed diagnosis can occurred by X-ray examination for upper cervical spine injury.For the patients with fracture displacement less than 3 mm,angulation deformity,hyperextension injuries and vertical compression injury of violence,spiral CT three-dimensional imaging after X-ray can improve the diagnosis accuracy,and avoid the poor prognosis.
Objective To observe the differences in radiological signs of cervical spine CT and X-ray in patients with upper cervical spine injury,and provide guidance for prognosis analysis. Methods The patients with atlas injury in our hospital from June,2014 to January,2015 were selected. X-ray and CT were performed in all patients before and after the treatment. To compare the difference in the morphologic changes of the injured cervical spine between X-ray and CT combined with the prognosis of patients. Results The accuracy rate of X-ray for fracture displacement less than 3 mm,angulation deformity,hyperextension injuries and vertical compression injury of violence was 26. 67%,50. 67% and16. 00%,respectively,which was lower than 42. 67%,66. 67%,42. 67% of CT( P < 0. 05); The correct diagnostic rate of spiral CT three-dimensional imaging technology was significantly higher than X-ray( 100. 00% vs. 80. 00%,P <0. 05); The poor prognosis of patients was correlated with the misdiagnosis or missed diagnosis( P < 0. 05).Conclusion The misdiagnosis and missed diagnosis can occurred by X-ray examination for upper cervical spine injury.For the patients with fracture displacement less than 3 mm,angulation deformity,hyperextension injuries and vertical compression injury of violence,spiral CT three-dimensional imaging after X-ray can improve the diagnosis accuracy,and avoid the poor prognosis.
引文
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[14]Ma C,Wu J,Zhao M,et al.Treatment of upper cervical spine instability with posterior fusion plus atlantoaxial pedicle screw[J].Cell Biochem Biophys,2014,69(3):693-697.
[15]Zou J,Yuan C,Zhu R,et al.Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor[J].Bmc Surgery,2014,14(1):30.
[16]孙安祥,王青,叶风娥.食管型颈椎病的临床症状与X线征象对照分析[J].今日健康,2014,13(5):12.
[17]苏洁,王辉.颈椎病的临床表现与X线征象对照分析(附400例报告)[J].中国社区医师,2014,30(24):116-118.
[18]赵月霞.CT技术在骨关节损伤中的应用[J].中国卫生标准管理,2015,6(20):173-174.
[2]Cappuccio M,Iure FD,Amendola L,et al.Occipito-cervical fusion in post-traumatic instability of the upper cervical spine and cranio-cervical junction[J].Eur Spine J,2013,22(6):900-904.
[3]Ahmadi SA,Slotty PJ,Munozbendix C,et al.Early surgical occipitocervical stabilization for plasma cell neoplasms at the cranio-cervical Junction:systematic review and proposal of a treatment algorithm[J].Spine J,2016,16(1):91-104.
[4]Abe M.MICEPs for upper cervical spine injury[J].Central Japan Journal of Orthopaedic Surgery&Traumatology,2014,57(5):1037-1038.
[5]Mustafy T,Moglo K,Adeeb S,et al.Investigation of upper cervical spine injury due to frontal and rear impact loading using finite element analysis[J].European Respiratory Journal,2014,36(4):925-949.
[6]Golinvaux NS,Basques BA,Bohl DD,et al.Bilateral Vertebral Artery Injury in a Patient with Upper Cervical Spine Fractures Leading to Fatal Vertebrobasilar Infarction:A Case Report[J].Orthop Surg,2015,7(3):281-285.
[7]Prasarn ML,Horodyski M,Scott NE,et al.Motion generated in the unstable upper cervical spine during head tilt-chin lift and jaw thrust maneuvers[J].Spine J,2014,14(4):609-614.
[8]Loubresse CGD.Diagnosis and Treatment of Upper Cervical Spine Trauma in the Elderly[M].Springer Berlin Heidelberg,2014,14:117-126.
[9]Vachhrajani S,Sen AN,Satyan K,et al.Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group[J].J Neurosurg Pediatr,2014,14(4):425-433.
[10]Ivancic PC.Cervical spine instability following axial compression injury:a biomechanical study[J].Orthop Traumatol Surg Res,2014,100(1):127-133.
[11]Yoshida N,Sasao Y,Isomi T,et al.Intradural extramedually spinal cord tumor of the upper cervical spine:a case of report[J].Neuromodulation Journal of the International Neuromodulation Society,2015,14(1):253-256.
[12]Joaquim AF,Ghizoni E,Tedeschi H,et al.Upper cervical injuries-a rational approach to guide surgical management[J].J Spinal Cord Med,2014,37(2):139-151.
[13]Lunardini DJ,Eskander MS,Even JL,et al.Vertebral artery injuries in cervical spine surgery[J].Spine J,2014,14(8):1520-1525.
[14]Ma C,Wu J,Zhao M,et al.Treatment of upper cervical spine instability with posterior fusion plus atlantoaxial pedicle screw[J].Cell Biochem Biophys,2014,69(3):693-697.
[15]Zou J,Yuan C,Zhu R,et al.Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor[J].Bmc Surgery,2014,14(1):30.
[16]孙安祥,王青,叶风娥.食管型颈椎病的临床症状与X线征象对照分析[J].今日健康,2014,13(5):12.
[17]苏洁,王辉.颈椎病的临床表现与X线征象对照分析(附400例报告)[J].中国社区医师,2014,30(24):116-118.
[18]赵月霞.CT技术在骨关节损伤中的应用[J].中国卫生标准管理,2015,6(20):173-174.