IMAGINGTheCERVICALSPINEInTheTRAUMAPATIENT成像在创伤病人颈椎.pptxVIP

会计学1IMAGINGTheCERVICALSPINEInTheTRAUMAPATIENT成像在创伤病人颈椎 A dr Z Lecture…on imaging cervical spine trauma.With much gratitude to Jack Harris, MD.第1页/共87页 Michael I. Zucker, MDProfessor, Dept. of Radiology Faculty, Dept. of Emergency Medicine UCLA Medical Center, David Geffen School of Medicine at UCLA第2页/共87页 10,000 spinal cord injuries per year in USATwo-thirds are cervical cord.The monetary, physical and emotional losses are great.Our goal: Early detection of injuries to prevent or decrease neurological and mechanical damage to the spinal column.第3页/共87页 STABILITY: A Word or TwoWe talk about it, but what is it?A useful definition: An injury is STABLE if putting the spinal column through normal range of motion does not increase neurological or mechanical deficits.第4页/共87页 Three Column Theory of DenisSpinal column divided into an ANTERIOR, MIDDLE and POSTERIOR column.Injury to one column is stable, two or three are unstable.第5页/共87页 ANTERIOR COLUMNThe anterior longitudinal ligament, anterior 2/3 of the body and disc.第6页/共87页 MIDDLE COLUMNPosterior longitudinal ligament and posterior 1/3 of body and disc.第7页/共87页 POSTERIOR COLUMNThe posterior osseous arch and ligaments.第8页/共87页 DOES IT WORK? If two or three columns injured, lesion is unstable: Works well for C3 to T1. Does not work so well for C1-2, so consider most or all injuries here unstable.第9页/共87页 HOW DO YOU IMAGE THE CERVICAL SPINE?Plain films?CT?MRI? A combination of modalities?Is there a consensus?第10页/共87页 NO(But we’re headed toward one)第11页/共87页 My Opinion:O*pin*ion: A belief held with confidence, but not substantiated by proof.第12页/共87页 Imaging Minor TraumaLATERAL view from skull base through at least the top one-half of T1. May need to supplement with Swimmer’s view.Anterior-posterior (AP)Open Mouth Odontoid (OMO)If patient is not in cervical collar: Adding Oblique views is an option.第13页/共87页 MINOR TRAUMA: Views第14页/共87页 Imaging Major Blunt TraumaCross-table LATERAL plain film in Trauma Suite.CT