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1、TheCERVICALSPINEImagingtheTraumatizedPatientMIZucker,MDAdrZLecture…onimagingcervicalspinetrauma.WithmuchgratitudetoJackHarris,MD.MichaelI.Zucker,MDProfessor,Dept.ofRadiologyFaculty,Dept.ofEmergencyMedicineUCLAMedicalCenter,DavidGeffenSchoolofMedicineat
2、UCLA10,000spinalcordinjuriesperyearinUSATwo-thirdsarecervicalcord.Themonetary,physicalandemotionallossesaregreat.Ourgoal:Earlydetectionofinjuriestopreventordecreaseneurologicalandmechanicaldamagetothespinalcolumn.STABILITY:AWordorTwoWetalkaboutit,butwh
3、atisit?Ausefuldefinition:AninjuryisSTABLEifputtingthespinalcolumnthroughnormalrangeofmotiondoesnotincreaseneurologicalormechanicaldeficits.ThreeColumnTheoryofDenisSpinalcolumndividedintoanANTERIOR,MIDDLEandPOSTERIORcolumn.Injurytoonecolumnisstable,twoo
4、rthreeareunstable.ANTERIORCOLUMNTheanteriorlongitudinalligament,anterior2/3ofthebodyanddisc.MIDDLECOLUMNPosteriorlongitudinalligamentandposterior1/3ofbodyanddisc.POSTERIORCOLUMNTheposteriorosseousarchandligaments.DOESITWORK?Iftwoorthreecolumnsinjured,l
5、esionisunstable:WorkswellforC3toT1.DoesnotworksowellforC1-2,soconsidermostorallinjurieshereunstable.HOWDOYOUIMAGETHECERVICALSPINE?Plainfilms?CT?MRI?Acombinationofmodalities?Isthereaconsensus?NO(Butwe’reheadedtowardone)MyOpinion:O*pin*ion:Abeliefheldwit
6、hconfidence,butnotsubstantiatedbyproof.ImagingMinorTraumaLATERALviewfromskullbasethroughatleastthetopone-halfofT1.MayneedtosupplementwithSwimmer’sview.Anterior-posterior(AP)OpenMouthOdontoid(OMO)Ifpatientisnotincervicalcollar:AddingObliqueviewsisanopti
7、on.MINORTRAUMA:ViewsImagingMajorBluntTraumaCross-tableLATERALplainfilminTraumaSuite.CTentirecervicalspine.MRIalsoinselectedcases.Ifyouwish,AP,OMO,andSwimmer’sviewsalso--IFtheyDONOTcausedelay.CT:AxialsectionsbaseofskullthroughT1-AND-Sagittal(likealatera
8、l)andCoronal(likeAPandOMO)reformatting.MAJORTRAUMA:ImagingCross-tableLateralinTraumaSuiteCTBaseofskullthroughT1Swimmer’sViewinMajorTraumaASUPPLEMENTARYviewtoseeC7-T1inlateralprojection.NOTasubstituteforabadlateral.Onearmmustbeelevated,s
