高エネルギー外傷における全脊柱CTの有用性に関する前向き調査

A Prospective Study of Spine Fractures Diagnosed by Total Spine Computed Tomography in High Energy Trauma Patients

　初期診療時に高エネルギー外傷における脊椎骨折が見逃されることがある．そのため，われわれは高エネルギー外傷全例に全脊柱CT検査を行ってきた．今回，高エネルギー外傷179例に対し全脊柱CTで発見された脊椎骨折を前向きに調査し，全脊柱CTの有用性を検討した．脊椎骨折は179例中54例(30.2％)に認めた．頚椎骨折16例中6例(37.5％)に，単純X線像では判明せずCTで骨折が判明した．全脊柱CTを撮影していなければ早期発見が困難であった胸腰椎骨折が，全胸腰椎骨折43例中6例(14.0％)存在した．以上の結果から，高エネルギー外傷では全脊柱CTは有用であり行うべき検査であると考えられた．

　Since it is known to be impossible to identify spinal fractures in high-energy trauma patients the primary trauma evaluation, we have been performing total spine computed tomography (CT) in high-energy trauma cases.　We investigated the spinal fractures that it was possible to detect by total spine CT in 179 cases and evaluated the usefulness of total spine CT prospectively.　There were 54 (30.2%) spinal fractures among the 179 cases.　Six (37.5%) of the 16 cervical spine fractures that were not detected on plain X-ray films were identified by total spine CT.　Six (14.0%) of 43 thoracolumbar spine fractures were considered difficult to diagnose based on the clinical findings if total spine CT had not been performed.　We therefore concluded that total spine CT is very useful and should be performed during the primary trauma evaluation in high-energy trauma cases.