高エネルギー頭部外傷における頚椎ルーチンCTの有用性―頚椎CTによって骨傷が判明した，いわゆる頚椎occult fractureの14例

Usefulness of Routine Cervical CT in High Energy Head Injury Patients. : 14 Cases of “Occult Fractures” Found During Cervical CT Scans

　われわれは，高エネルギー外傷で当センターを受診した頭部外傷患者全例に頚椎CTをルーチンで施行し，頚椎単純X線写真上骨傷を判定しえなかった103例中13例（12.6％）に頚椎CT上骨傷を認めた．現在までに経験した，いわゆる「頚椎occult fracture」の14例について検討した．今回の結果から，頚椎単純X線写真上骨傷を認めなくとも，実際は頚椎に骨傷を伴っているケースが高い割合で潜在していることが示唆された．高エネルギー外傷において頭部に外傷を認める場合は，頭部CTに加え頚椎CTをルーチンに施行することは有用であると思われた．

　We routinely performed cervical CT scans in addition to head CT examinations on patients with blunt head traumas who had received high energy injuries. Although no fractures were seen on the plain films in 103 cases, the additional cervical CT examinations revealed 14 cervical fractures in 13 (12.6％) of these cases. We experienced an additional case, and here we report a total of 14 cases of “occult cervical spine fractures”. For patients with blunt head traumas, a cervical CT examination is not usually performed if no evidence of a cervical fracture is found on plain films and no neurological deficits are present. Nevertheless, the present findings suggest that many cervical fractures may have been missed on plain films in the past, and the routine inclusion of a cervical CT examination might be appropriate for the evaluation of patients with blunt head trauma who have received a high energy injury.