胸、腰椎骨折的影像学诊断.docVIP

Imaging of Thoracic and Lumbar Spine Fractures胸、腰椎骨折的影像学诊断Mark W. Anderson, MDFractures of the thoracic and lumbar spine are common in patients who have sustained highenergy spinal trauma, and are associated with injury to the spinal cord in up to 50% ofcases. Accurate early assessment is essential because delay in diagnosis may result in thedevelopment of neurologic complications. Clinical assessment of these patients is oftenchallenging, and as a result, diagnostic imaging usually plays a central role in theirmanagement. The purpose of this chapter is to explore this role by answering the followingquestions: What are the imaging options? Who should be imaged? How should they beimaged? and What are the imaging ?ndings for the most common types of thoracolumbarfractures?在高能量脊柱创伤患者中，胸腰椎骨折较为常见，50%以上的病例可以出现脊髓损伤。因此，对于胸腰椎骨折的早期评估非常重要，因为延误诊断可能会导致神经功能并发症的发生。对于胸腰椎骨折患者的临床评估难度较大，因此影像学检查在其诊断中占据了中心地位。本文旨在对以下问题做初步的探索：影像学检查的选择有哪些？那些患者应该进行影像学检查？如何检查？常见的胸腰椎骨折影像学表现有哪些？【正文部分】Fractures of the thoracic and lumbar spine are usually theresult of high-energy injuries such as motor vehicle acci-dents or falls from a signi?cant height. They have been re-ported to occur in 4%-5% of patients arriving at a level 1trauma center and are associated with spinal cord injury inup to 50% of cases. Accurate early assessment is essentialbecause delay in diagnosis may result in the development orprogression of neurologic complications. Clinical assess-ment can be challenging, particularly in a patient with an altered level of consciousness or a “distracting” injury else-where, and a delay in diagnosis has been reported to occur inup to 20% of these fractures, most often secondary to insuf-?cient imaging.胸腰椎骨折常见的致伤原因为高能量创伤，如车祸或高处摔伤。1级创伤中心所接受的病例中，约4%-5%为胸腰椎骨折，同时这些患者中伴有脊髓损伤的高达50%以上。因此，对于胸腰椎骨折的早期评估非常重要，因为延误诊断可能会导致神经功能并发症的发生。当患者意识不清或伴有其他部位的损伤时，临床评估往往难以进行。据报道，延误诊断的概率可达到20%，其原因往往是没有进行必要的影像学检查。The purpose of this chapter is to review the role of diag-nostic imaging in the work-up of patients with suspect