颈椎骨折脱位脊髓损伤的救治  

The First Aid and Treatment for the Cervical Spinal Cord Injury Caused by Cervical Frac-ture and Dislocation

作　　者：王义生[1] 翟福英[1] 王利民[1] 许建中[1] 张毓洲[1] 皮国富[1] 夏磊[1] 廖文胜[1] 王卫东[1] 

机构地区：[1]郑州大学第一附属医院骨科,河南郑州450052

出　　处：《实用骨科杂志》2007年第1期13-16,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨颈椎骨折脱位脊髓损伤的救治。方法急救并手术治疗颈椎骨折脱位脊髓损伤295例。受伤时间平均4.5d(5h^12周)。其中,骨折140例,骨折并脱位119例,单纯脱位20例,小关节突绞锁16例。损伤部位:C417例,C529例,C639例,C735例;C4~538例,C5~658例,C6~749例;C4~616例,C5~714例。按照Frankel分级,A级20例,B级91例,C级124例,D级60例。给予颈部制动,物理降温或保暖,吸氧,激素、脱水药等。236例行颈前路扩大脊髓减压术,31例行后路手术,28例行一期后前路手术。结果术后平均随访11.8年(0.5~18年),脊髓、神经功能有1级以上恢复者178例,总有效率为60.3%。以颈椎轻度压缩骨折并颈椎间盘脱出的效果最佳,优良率达到了88.0%。关节突交锁、韧带损伤、血肿等行后路手术者的效果亦佳,优良率达87.1%。结论救治颈髓损伤,应及早制动颈部,应用激素、脱水药物。掌握适应证尽早手术,可获一定疗效。根据脊髓受压情况,手术入路可选择前路、后路或一期后前路手术。并应积极防治并发症。Objective To study the effect of first aid and treatment for the cervical spinal cord injury and dislocation underwent the surgery. Methods The mean of the injury history was 4. 5 days with a range of 5 hours- 12 weeks. There were 140 cases with cervical fracture ,in which 50 cases with lightly compressing fracture and disc hernaiation, 119 cases with cervical fracture and dislocation, 20 cases only with dislocation,and 16 cases with articular process wringed in this group. The injury level was C4 in 17 cases,C5 in 29,C6 in 39,C7in 35,C4-5 in 38,C5-6 in 58. C6-7 in 49,C4-6 in 16,and C5-7 in 14. According to the classification of Frankel,grade A was in 20 cases,grade B in 91,grade C in 124,and grade D in 60. The first aid include the braking neck.reducing the temperature if high fever, snuff oxygen, and using steroid, dehydration medicine, energy, neurotrophy medicine and so forth. 236 patients were treated with anterior enlarged decompression. 31 patients with the cord compressed from posterior side were treated by posterior approach surgery. 28 patients with the cord compressed from both of anterior and posterior sides were treated by anterior and posterior surgery one time. Results All patients were obtained follow-up for 0. 5-18 years with a mean of 11.8 years. The results showed that 178 patients got the restore in the function of the spinal cord and nerve,at least advanced one grade. The total effective rate was 60.3%. The best results were obtained from the cases with the cervical lightly compressive fracture and the disc hernia（88.0%）. Conclusion In the first aid and treatment for the spinal cord injury caused by cervical fracture and dislocation. The braking neck,using steroid and dehydration medicine should not be ignored. The better effect may be obtained with early and quite removing the compressive elements to the spinal cord and stabilizing the cervical spine. The complications should be actively prevented and treated.

关 键 词：颈椎 脊髓损伤 救治 

分 类 号：R683.2[医药卫生—骨科学]