Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group
Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group
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DOI：
10.1097/01.brs.0000214940.11096.c8
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发表时间：
2006-04-20
期刊：
影响因子：
3
通讯作者：
Vaccaro, AR
中科院分区：
文献类型：
--
作者：
Kuklo, TR;Potter, BK;Vaccaro, AR
研究设计。文献综述。目的。脊柱创伤研究组的成员评估了各种成像方法，并编制了标准化方法来进行放射学测量以评估骶骨骨折。背景数据摘要。骶骨骨折的诊断经常被漏诊或延误，治疗方法也存在争议，关于非手术治疗、神经减压和内固定的建议存在很大差异。缺乏具体的放射线照相测量和标准来帮助临床医生做出正确的治疗决策。这可能迫使外科医生根据非标准化、未经验证的建议和措施以及在某些情况下的轶事证据来做出临床决策。我们认为，迈向有效和最佳临床决策的关键第一步需要准确和清晰地定义用于评估骶骨损伤和收集未来研究数据的成像测量参数。对英语文献进行了回顾，以评估目前使用的骶骨骨折的放射线照相测量技术。这使得可以制定详细的射线照相评估，旨在更可靠地描述骶骨骨折形态测量。结果。这些测量包括：前后骶骨骨折位移（骨盆轴向计算机断层扫描 [CT]）、垂直骶骨骨折位移（冠状 CT 重建）、前后平移和后凸角度（矢状 CT 重建）以及中央管受累和椎间孔侵入程度（轴向 CT 精细切割以及冠状和矢状重建）。应考虑的其他可能影响治疗结果的影像学因素包括骶骨骨折的水平和类型、腰骶交界处和骶髂关节受累以及相关的骨盆环损伤。结论。通过采用这些放射学指南，未来的研究将有一个统一的方法来描述骶骨损伤，从而可以研究各种推荐治疗方案的疗效。
Study Design. Literature review.Objectives. Members of the Spine Trauma Study Group evaluated various imaging methods and compiled standardized approaches to making radiographic measurements for the assessment of sacral fractures.Summary of Background Data. The diagnosis of sacral fractures is frequently missed or delayed, and the treatment is controversial, with significant variations in recommendations regarding nonoperative treatment, neural decompression, and internal fixation. A paucity of specific radiographic measurements and criteria exist to aid the clinician in making sound treatment decisions. This may obligate surgeons to base clinical decisions on nonstandardized, nonvalidated recommendations and measures and, in some cases, anecdotal evidence. We think that a critical first step toward valid and optimal clinical decision-making requires an accurate and clear definition of imaging measurement parameters used to evaluate sacral injuries and gather data for future studies.Methods. A review of the English-speaking literature was performed to assess cited radiographic measurement techniques of sacral fractures currently in use. This allowed the formulation of detailed radiographic assessments designed to more reliably describe sacral fracture morphometry.Results. These measurements include: anterior-posterior sacral fracture displacement (axial computed tomography [CT] of the pelvis), vertical sacral fracture displacement (coronal CT reconstruction), anterior-posterior translation and kyphotic angulation (sagittal CT reconstructions), and degree of central canal involvement and foraminal encroachment (axial CT with fine cuts and coronal and sagittal reconstructions). Other radiographic factors that should be considered that may impact treatment outcomes include the level and type of sacral fracture, lumbosacral junction and sacroiliac joint involvement, and associated pelvic ring injury.Conclusions. With adoption of these radiographic guidelines, future studies will have a uniform method in which to describe sacral injuries and therefore allow study of the efficacy of various recommended treatment protocols.