4. Acute imaging
4. 急诊影像学检查
The most recent ATLS protocol (2009) advises a series of trauma radiographs (chest and pelvis) for polytrauma patients as adjuncts to the primary survey, though there is mounting opinion that they add little in the stable patient where CT will be performed anyway[2,3]. The rationale for the pelvic radiograph is because of the high risk of bleeding from pelvic fractures.
最新ATLS草案(2009)建议对多发伤患者进行一系列作为初步检查附属项目的放射学检查，尽管越来越多的观点认为这对于必行CT检查的稳定患者意义不大[2,3]。对骨盆进行X线检查的道理在于骨盆骨折常合并出血的高风险。
Pelvic radiographs increase radiation exposure, can cause delays and have been shown to lack sensitivity in detection of fractures with ?gures quoted to be around 67–68% [2,3]. The role of the pelvic radiograph is certainly diminishing and, provided there is access to prompt CT, there is an argument to omit them from the initial management plan completely.
骨盆X线检查增加了患者射线接受剂量，并可引起病情延误，引用的数字显示，大约67–68%的骨盆骨折X线检查敏感度不足[2,3]。假如有使用快速CT的机会，骨盆X线检查的作用势必逐渐减小，有观点认为应将其从初步诊疗计划中完全忽略。
Integrating a trauma CT (head, spine, chest, abdomen and pelvis)into the resuscitation algorithm enables a fast, early diagnosis and facilitates further management (Fig. 1a–c). This allows full evaluation of the patient, in addition to giving detailed images of the bony pelvis and any associated complications.
将创伤CT检查(头、脊柱、胸部、腹部和骨盆)整合到复苏法则中能够快速、早期作出诊断并有助于实施进一步诊疗(图. 1a–c)。除了提供骨性骨盆和任何相关并发症的详细影像外，尚能够对患者做出全面评估。
图1：(a–c) 遭受高速公路交通事故的男性患者，到达急诊室时已出现血流动力学不稳，平片显示耻骨支、骶骨和右股骨多发骨折(a)。由此推测可发生继发性出血，CT显示左硬膜外出血、颅骨骨折合并气颅(b, 箭头所示)。尚有一处未曾预料到的复杂肝损伤，造影剂外溢(c, 箭头所示)。无活动性骨盆出血。
Many patients with pelvic injuries are haemodynamically unstable. Current ATLS advice that CT is contraindicated in these patients can be challenged. At present ATLS recommends FAST scanning (focussed assessment sonography in trauma) or DPL (diagnostic peritoneal lavage) and a pelvic radiograph for such patients [1]. Neither ultrasound or DPL will demonstrate the source of the bleeding, nor can they assess the retroperitoneum or pelvic musculature and the radiograph will demonstrate only the bony anatomy. CT, by contrast, assesses all of these areas very well and very quickly.
许多骨盆损伤的患者存在血流动力学不稳。最新ATLS对此类患者禁忌行CT检查的建议受到挑战。目前ATLS推荐对此类患者行FAST扫描(对创伤患者集中评估超声检查)或DPL(诊断性腹膜腔灌洗)和骨盆X线检查[1]。超声或DPL既不能确认出血源，也不能评估腹膜后隙或骨盆肌肉组织状况，并且X线片仅能证实骨结构情况。CT则不同，能够准确、快速的评价所有这些部位。
