颈椎损伤X线平片阅读技巧.docx

How to read a C-spine filmWhile emergency physicians are increasingly utilizing C-spine CT (especially in high-risk patients and those already getting a head CT), familiarity with the reading of the cervical spine x-ray is a skill that falls solidly within the scope of the ED physician. Below we will review the ten steps to reading a c-spine xray. One way to remember these steps is AAABBBCs.Step: 1 adequacy- make sure that you can visualize the entire C spine to the C7-T1 interface-***failure to visualize the seventh cervical vertebra and the CT/TI junction is the most common error made in the radiographic assessment of cervical spine injuryStep: 2 alignment-make sure there is no rotation present (rotation will be seen when left and right diamond-shaped lateral masses of each vertebra are not superimposed as below) -Make sure the the anterior longitudinal ligament line (also anterior vertebral line), posterior longitudinal ligament line (also posterior vertebral line), spinolaminar line and tips of spinous processes fall along a smooth and continuous line.Step: 3-Make sure the the anterior longitudinal ligament line (also anterior vertebral line), posterior longitudinal ligament line (also posterior vertebral line), spinolaminar line and tips of spinous processes fall along a smooth and continuous line. Emergency Medicine a Comprehensive Study Guide, 6th edition, 2004. Mc-Graw-Hill.Step: 3 AADI anterior atlantdental interval- make sure the anterior atlantodental interval (also called pre-dental space) is less then 3 mm in adults and less than 5 mm in childrenStep: 4 BDI( basion dental interval)-make sure the basion-dens interspace is less than 12 mm (see examples below of a normal and abnormal BDI)Step: 5 base of dens-make sure the ring of C2 is smooth and continousCheck for a fat C2Step: 6 bony abnormalities- Inspect each bone (vertebral body, pedicle, articular mass, lamina, spinous process) from top to bottom- *** the majority of missed fractures are at the upper