У мамы были межпозвоночные грыжи. После операции сильные боли уже 10 дней. Во время операции было сильное кровотечение. Врачи говорят, что возможно есть гематома и она давит на нервы и из-за этого боли. МРТ в городе поломан. Скажите пожалуйста имеет ли смысл делать миелографию или она не покажет есть гематома или нет?
при отсутствии МРТ после операции лучще избежать инвазивных процедур , а сдклать КТ с контрастом- покажет и гематому и грыжи.
С уважением,
Др.Гофман Алекс
Ортопед,спинальный хирург
Больница Рамбам, Хайфа,Израиль
http://www.alex-gofman.dpages.co.il/apage/59694.php
dr.alexgofman@012.net.il
спасибо за ответ...
наш врач на КТ сказал, что гематомы не накапливают контраст и делали КТ без контраста... КТ ничего не показала... скоро повторная операция...
Есть масса литературы на эту тему(но конечно МРТ с контрастом - это золотой стандарт в спинальной хирургии а вот в травме общей- очень широко этим пользуются)
например- выдержки
http://www.diagnosticimaging.com/dimag/legacy/advancedCT2002/10.html
Rapid multidetector imaging assesses multiple injuries in stable patients
Trauma CT offers one-stop diagnosis
By: Mark P. Bernstein, M.D., And Stuart E. Mirvis, M.D.
Contrast-enhanced CT provides identification and precise delineation of organ and vascular injury, such as hematoma and active arterial extravasation, and indicates the presence of urinary extravasation or devitalized parenchyma. It can also differentiate trivial injuries from those requiring intervention.
Journal of Trauma-Injury Infection & Critical Care:
March 2007 - Volume 62 - Issue 3 - pp 740-745
doi: 10.1097/01.ta.0000235508.11442.a8
Original Articles
Contrast-Enhanced CT Accurately Detects Hemorrhage in Torso Trauma: Direct Comparison With Angiography
Maturen, Katherine E. MD; Adusumilli, Saroja MD; Blane, Caroline E. MD; Arbabi, Saman MD, MPH; Williams, David M. MD; Fitzgerald, James T. PhD; Vine, Adrian A. BSE
Abstract
Objective: To assess the ability of contrast enhanced computed tomography (CECT) to detect active hemorrhage and other vascular injuries in chest, abdominal, and pelvic trauma patients, using angiographic findings and need for intervention as paired gold standards.
Methods: We obtained approval from the Institutional review board for a retrospective search of the radiology information system: seeking trauma patients undergoing angiography within 24 hours of CECT for chest, abdominal, or pelvic injuries. CECT protocol was standard trauma CT, not specialized for CT angiography. Angiographic techniques varied with indication. Clinical and imaging reports and selected radiologic studies were reviewed, but the original dictated report was the interpretive standard. We used Fisher's exact test for statistical analysis.
Results: During the 30-month study period, 466 patients underwent emergent interventional radiologic procedures. Of those, 418 were excluded for nontrauma indications or neuroangiographic procedures. Fourty-eight patients (33 male, 15 female, average age 43.4) thus constituted the study population in whom we evaluated 63 traumatic injuries. CT findings had statistically significant associations (p < 0.0001) with both angiographic evidence of active hemorrhage and the need for intervention, which were tabulated separately. CT had 94.1% sensitivity and 97.6% negative predictive value (NPV) for detection of active hemorrhage, and 92.6% sensitivity and 91.2% NPV for predicting need for surgical or endovascular intervention.
Conclusions: CECT findings correlate strongly with angiographic findings, though sensitivity remains imperfect. However, when CT is used in the context of other clinical features, particularly hemodynamic instability, it may enable clinicians to reserve emergent angiography for those patients in whom emergent intervention is planned.
С уважением, удачи на операции
Др.Гофман Алекс
Ортопед,спинальный хирург
Больница Рамбам, Хайфа,Израиль
http://www.alex-gofman.dpages.co.il/apage/59694.php
dr.alexgofman@012.net.il