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常规还是必须的? 重新评估宫CT在老年人头部创伤中的使用 - - 德国一级创伤中心的回顾性分析

Josina Straub¹, Julia E Lenz¹, Leopold Henssler¹

¹Clinic and Policlinic for Trauma Surgery.

Clinical spine surgery

|March 2, 2026

Study Design:

老年队列中头部撞击后颈椎损伤的回顾性分析

目的:

老年头部外伤患者发生继发性颅内损伤的风险增加。由于临床检查可及性较差，常需进行计算机断层扫描（CT）。

背景资料摘要:

常规颈椎CT成像在颅脑计算机断层扫描（cCT）基础上的临床意义尚不明确。本研究计算了老年队列中头部创伤后连续发生的颈椎损伤（CSI）的患病率、危险因素以及筛查所需人数（NNS）。

方法:

对2020年1月至2024年10月期间在德国一家一级创伤中心就诊的65岁及以上患者进行了一项回顾性分析，这些患者在头部撞击后均接受了脑部CT（cCT）和颈椎CT成像检查。

结果:

在2157例患者中，女性占55.9%，63.6%的患者年龄大于或等于80岁。感觉运动功能障碍检出率为1.5%。颅内损伤（CSIs）检出率为5.5%，其中10.9%的患者需要手术治疗。识别出的危险因素包括女性性别（OR=1.6；P=0.006）、既往痴呆病史（OR=1.4，P=0.01）、经复苏室入院（OR=1.6；P=0.05）以及颅内出血（OR=1.5；P=0.03）。对于年龄大于或等于65岁的患者，检出一例CSIs所需的筛查人数（NNS）为18.1，年龄大于或等于80岁的患者NNS为17.6。对于无症状患者，年龄大于或等于65岁者的NNS为19.3，年龄大于或等于80岁者的NNS为18.5。需要手术干预的NNS在年龄大于或等于65岁的患者中为165.9，在年龄大于或等于80岁的患者中为171.4。

结论:

老年颅脑创伤患者中，颈椎损伤（CSI）常为并发情况。当需要进行头颅CT（cCT）检查时，应常规考虑行颈椎CT成像，因其可及时发现颈椎损伤，并直接影响临床决策。较低的需检人数（NNS）凸显了常规颈椎CT成像的价值，支持其更广泛的应用，以预防并发症并改善患者预后。

证据等级:

三级调查

关键词:

宫脊椎损伤的发生老年患者的患者.头部创伤是什么意思需要选的数字.有关风险因素的风险因素.

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