螺旋CT三维重建在上颈椎损伤的诊断中的作用分析

摘要

Objective:To investigate clinical application value of spiral CT three-dimensional reconstruction in diagnosis of upper cervical spine injury. Method:18 cases of patients with cervical spine injury on X-ray and spiral CT images in our hospital from January 2010 to April 2013 were reviewed.The value of spiral CT three-dimensional reconstruction in diagnosis of upper cervical spine injury were analysed.Result:18 patients,fracture spiral CT findings of 20 parts:2 cases of atlas burst fracture,12 cases of odontoid fractures,2 cases of atlantoaxial vertebral fractures,4 cases of atlantoaxial arch fracture;4 cases of found dislocation:1 case of atlanto-occipital dislocation,3 cases of atlantoaxial dislocation.X-ray examination revealed the fracture site of 12 parts:1 case of fracture of the atlas,7 cases of odontoid fracture,2 cases of atlantoaxial vertebral fractures,2 cases of atlantoaxial arch fracture,misdiagnosis rate of 40%;2 cases of found dislocation:2 cases of atlantoaxial dislocation,misdiagnosis rate of 50%;Including 4 cases of atlantoaxial fractures misdiagnosed as atlantoaxial dislocation. Conclusion:Anatomy of the upper cervical spine because of its complex and subtle,upper cervical spine injury combined with three-dimensional reconstruction of spiral CT scans,can be clearly demonstrated upper cervical spine fracture,dislocation and secondary spinal stenosis,etc.Contribute to the clinical development of treatment programs timely and accurate.%目的：探讨分析螺旋CT三维重建在上颈椎损伤诊断中的作用和应用价值。方法：回顾性分析2010年1月-2013年4月在笔者所在医院进行诊治的18例上颈椎损伤患者的X线平片及螺旋CT三维重建图像，评价螺旋CT三维重建在上颈椎损伤诊断中的作用。结果：本研究18例患者中，螺旋CT三维重建发现骨折共20个部位：寰椎爆裂性骨折2例，枢椎齿状突骨折12例，枢椎椎体骨折2例，枢椎椎弓骨折4例；发现脱位共4例：寰枕关节脱位1例，寰枢关节脱位3例。X线片检查发现骨折部位共12个部位：寰椎骨折1例，枢椎齿状突骨折7例，枢椎椎体骨折2例，枢椎椎弓骨折2例，漏诊率40%；发现脱位共2例：寰枢关节脱位2例，漏诊率50%；其中4例寰枢椎骨折误诊为寰枢椎脱位。结论：上颈椎因其解剖结构复杂而细微，上颈椎损伤的螺旋CT扫描结合三维重建，能明确显示上颈椎骨折、脱位及继发椎管狭窄等情况，有助于临床及时准确地制订治疗方案，是一种临床术前诊治该疾病的首选检查方法。