颈椎闭合复位对椎间盘和脊髓损伤的影响  

Effect of closed traction reduction of cervical spinal facet dislocation on the DISC and spinal cord injuries

作　　者：苏琦[1] 任先军[1] 张峡[1] 王卫东[1] 蒋涛[1] 

机构地区：[1]第三军医大学附属新桥医院骨科,重庆400037

出　　处：《颈腰痛杂志》2005年第2期89-92,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨下颈椎小关节脱位闭合复位的临床疗效。方法46例颈椎小关节脱位患者, 24例单侧小关节脱位,22例双侧小关节脱位,在透视下行颅骨牵引闭合复位,并于复位前后进行神 经功能和颈椎MRI检查,借以比较复位前后椎间盘损伤和脊髓实质性损伤的变化情况。结果46例 中39例在透视下行颅骨牵引闭合复位,其中34例复位成功,5例未成功,成功率87％。34例中复位 前MRI显示存在明显椎间盘突出者7例,椎间盘撕裂4例,复位后有6例椎间盘脱出仍存在,大小 无明显变化;1例原脱出椎间盘明显缩小,无新椎间盘脱出发生。33例在复位前后脊髓信号无明显改 变,1例复位前脊髓无明显改变者,复位后出现T2加权高信号。结论1、透视下颅骨牵引闭合复位是 一种安全有效的治疗方法,通常情况下不会诱发或加重椎间盘脱出,进而造成继发性脊髓功能损伤。 2、MRI对颈椎小关节脱位合并椎间盘和脊髓损伤的诊断、预后的参考价值高,但不应因行MRI检查 而耽误闭合复位。Objective To explore the clinic effects of closed traction reduction of cervical spinal dislocation. Methods There were 46 cases with cervical spine facet dislocation, 24 unilateral and 22 bilateral. All patients were undergone neurological function and cervical spine MRI examin-nation before and after closed traction reduction. The disc herniation and spinal cord injury were compared. Results Closed traction reduction were done in 39 of 46 patients,and successful in 34 patients,but 5 unsuccessful,successful rate was 87%. 7 of 33 patients had disc herniation,4 of 33 patients had disc disruption and 23 of patients had no disc injury before reduction. After closed traction reduction,6 patients remained similar herniation,one patient showed obviously reduced disc hemiation compared with that before reduction. There were no new disc herniation after reducton. 33 patients had no changes of spinal cord sign on MRI before and after closed traction reduction. One patients had increse high density sign on MRI T2WI imaging.But there were no neurological worsening after reduction. Conclusion 1.Skull traction reduction is a safe and effective treatment,It could not increase the disc herniation and cause further spinal cord injury. 2.Patient with cervical spine dislocation can undergo immediate closed traction reduction without delaying to obtain a pre-reduction MRI when they are awake and cooperative with neurological testing.

关 键 词：颈椎 小关节脱位 闭合复位 脊髓损伤 

分 类 号：R744.2[医药卫生—神经病学与精神病学]