胸腰椎外伤后脊髓损伤CT平扫的局限性

Limitation of CT plain scan in the diagnosis of spinal cord injury after thoracolumbar spine trauma

目的探讨CT平扫诊断胸腰椎外伤后脊髓损伤的局限性。方法收集近7a来48例胸腰椎外伤的CT平扫结果、X线片结果及临床资料,并进行对比分析。结果48例胸腰椎外伤病人中椎体骨折73个,单发59个,多发14个,其中CT示碎骨入椎管内的有25处,血肿1处,附件骨折36处,X线片漏报附件骨折16处(44%)。瘫痪病人11例,均经手术治疗,术中发现椎管内碎骨15处,血肿2处,脊髓挫伤或断裂10处。结论CT平扫对椎体、附件骨折、椎管形态改变和碎骨片移位及明显的椎管内血肿的诊断,优于X线平片,但是对脊髓损伤的显示有局限性,建议胸腰椎外伤后瘫痪病人做脊髓造影(CTM)或磁共振成像(MRI)。

Objective To discuss the limitation of CT in the diagnosis of spinal cord injury that is secondary to thoracolumbar spine trauma.Methods CT,X- ray findings and clinical data of 48 patients with thoracolumbar spine traum were collected and correlated each other.Results CT showed broken bone entered into the vertebral canal in 25 locations, hematoma in 1,appendixes fracture in 36,X- ray leak- diagnosed appendix fracture in 16 (44 % ).Eleven patients with paralysis due to thoracolumbar spine trauma underwent the surgery.The surgery found broken bone within vertebral canal in 15,hematoma in 2,and spinal cord bruise or break in 10 cases.Conclusion CT plain scans are significantly superior to X- ray plain films for diagnosing the vertebral body and appendix fracture,the changes of vertebral canal form,the displacement of broken bone or hematoma in vertebral canal but it has certain limitation for revealing the spinal cord injury so that CT myelography (CTM) or magnetic resonance imagins (MRI) should be recommended in high- risk paralysis patients who require screening after thoracolumbar spine trauma. [