与急性外伤相关脊椎X线诊断的争议和对策

目的探讨因急性脊椎外伤X线检查而发生的争议及采取的对策.资料与方法本组12例,均有不同程度的急性外伤史.X线检查部位:颈椎3例,胸椎2例,腰椎7例.全部病例均摄正、侧位X线片,根据需要加照颈椎张口位片或斜位片.加做CT 6例,MRI 6例.结果张口位环枢椎片诊断半脱位不可靠,CT可准确观察有无脱位;椎体楔形变可以是急性压缩性或陈旧性骨折,MRI可根据信号改变作出鉴别;椎缘骨并非外伤所致,而是椎间盘脱出,MRI可明确诊断;真性和假性滑脱与急性外伤无关联,CT和MRI均可提供帮助.结论急性外伤脊椎X线诊断如发生上述争议,应采取的对策是根据不同情况加做CT或MRI检查.

The Controversy and Strategies of X-ray Diagnosis Related to Acute Spine Injuries

Objective To discuss controversy and strategies of X-ray diagnosis related to acute spine injures. Materials and Methods There were 12 cases in this group, X-ray examination included cervical spine in 3, thoracic spine in 2 and lumbar spine in 7, All were projected in frontal and lateral position, some of them were also checked with open-mouth view and oblique view, In addition, CT and MR were applied in 6 cases respectively, Results It was not reliable in open-view projection, but accurate in CT for atlantoaxial subluxation; acute or chronic fracture could induce the wage-like deformation of vertebral body, which could be differentiated by MR according to the signal of different phase, Meanwhile, MR could display intervertebral disc protrusion led to the limbus vertebra which misdiagnosed as injury. CT and MR could provide some assistance for true spondylolisthesis and pseudospondylolisthesis, which had no relation to acute injury. Conclusion If there are some controversy, the CT and MR can be applied to make it clear, according to the individual condition.