螺旋CT三维重建对上颈椎损伤的诊断价值.docVIP

　　螺旋CT三维重建对上颈椎损伤的诊断价值 作者：朱岩　向卫国　梁文杰　王奕 【摘要】 　　［目的］探讨螺旋CT三维重建在上颈椎损伤的诊断中的作用。［ 方法 ］ 总结 26例寰枢椎损伤病例。统计骨折分类，诊断正确率，CT扫描参数，后期处理方法。着重观察上颈椎骨折的部位，椎体序列，椎体高度，骨折线，椎体附件骨折和旋转/脱位等的CT表现,并评价3D重建图像的优势。［结果］26例中C1爆裂性骨折(Jefferson骨折)4例,其中1例合并C1、2脱位失稳;C2齿状突骨折17例,其中X线片漏诊1例;C2椎弓骨折(Hangman骨折)1例;单纯C1、2椎间失稳2例,其中X线片漏诊1例。枢椎椎体骨折，本组中2例，为椎体纵行骨折，骨折无明显移位。在26例寰枢椎骨折病例中，CT全部正确诊断，X线诊断正确17 例，占 65％，其中6例未能作出诊断，3例将寰枢椎骨折误诊为关节脱位。上颈椎即寰枢椎解剖结构复杂，有与其它颈椎不同的解剖学特征，螺旋CT三维重建能清晰显示上颈椎的解剖关系、椎管形态、骨折块移位情况以及与周围软组织的关系,特别对于C1爆裂性骨折、C2齿状突骨折、C1、2脱位可提供逼真立体影像信息,清晰地显示C1侧块移位的大小，C1、2间移位的程度,可将图像任意旋转,以不同角度观察或展现任意断面,观察骨折碎片移位，断端锐利及其与椎管的关系,评估颈枕间和C1、2椎间稳定性，对伤情评估,是否手术，选择手术方式和手术风险的评估有重要的指导作用。［结论］上位颈椎骨折的螺旋CT扫描和三维重建,可更好显示骨折的情况, 可作为上颈椎损伤临床术前诊断和 治疗 的影象学检查的首选方法。 【关键词】 颈椎骨折 螺旋CT 三维重建 多平面重建 　　Diagnostic value of 3D reconstruction age features and clinical significance of 3dimensional (3-D)and multiplanar reconstruction radiography and spiral CT scanning eter of scanning and late stage managing methods agin location of fractures,sequence of cenrum, hEighth of centrum, fracture line, auxillary structure and rotation/dislocation of the fractures phasized to evaluate the advantages of 3-D imaging.［Result］In the 26 cases, there an fracture, 2 C1～2 imbalance, (in isdiagnozing as dislocation.The anatomical structure of upper cervical spine other cervical spine constructions. Spiral CT could reveal high resolution images of the upper cervical spine, morphosis of vertibral canal, dislocation information of fracture mass and its relation ation of the size of collateral mass and the dislocation degree, furthermore, images could be rotated freely to observe the fracture in any proper section. That provides important information for the decision of operation, selection of operation types and evaluation of operation dager.［Conclusion］The spiral CT scan and 3D reconstruction can reveal fracture better .The advantages of SCT are suggested that this diagnostic modality may be the standard method for the initial evaluation of the upper cervical spine injury.