过伸性颈椎损伤合并颈椎间盘撕裂伤的诊治  

Diagnosis and surgical treatment of hyperextension cervical spine injury combined with intervertebral disk injury

作　　者：徐兆万[1] 庄青山[1] 葛吉玉 王炳武[1] 隋国侠[1] 冀旭斌[1] 

机构地区：[1]潍坊市人民医院脊柱外科,261041 [2]胶志市中医院骨科

出　　处：《中华创伤杂志》2009年第7期594-597,共4页Chinese Journal of Trauma

摘　　要：目的探讨过伸性颈髓损伤合并颈椎间盘撕裂伤的诊断和前路手术治疗效果。方法回顾性分析27例过伸性颈髓损伤合并颈椎间盘撕裂伤患者的临床资料，对其年龄分布、临床表现、X线和MRI表现、术中椎间盘损伤情况进行分析。均采用颈椎前路椎间盘切除、椎体间植骨和内固定术，依据术前、术后Frankel分级情况，ASIA运动功能评分（AMS）和改善率评价治疗效果。结果所有患者MRI、X线片均提示不同的病理改变，以椎前阴影增宽、椎前间隙增宽、椎间盘突出、脊髓压迫及水肿为突出特点。除1例FrankelA级患者神经功能无明显恢复外，其余患者术后均有1～3个等级的恢复。随访9～32个月，平均17．5个月。与入院时相比，术后2个月和末次随访时AMS明显增高，运动功能恢复率分别为44．9％和68．1％，差异有统计学意义。未见内置物松动、脱落或断裂等并发症，固定节段均获得骨性融合。结论MRI和X线检查是过伸性颈椎损伤合并椎间盘撕裂伤的重要诊断手段，一旦诊断明确应行颈椎前路手术治疗，可获得较理想的脊髓功能恢复。Objective To discuss diagnosis and anterior surgical treatment of hyperextension cervical spine injury combined with intervertebral disk injury. Methods A retrospective study was done on clinical data of 27 patients who suffered from hyperextension cervical spine injury combined with intervertebral disk injury to analyze their age distribution, clinical symptomes, X-ray and MRI manifestations and perioperative intervertebral disk injury. All patients were treated with discectomy, strut bone grafting within vertebral bodies and internal fixation with titanium plate. The clinical outcomes were evaluated by using Frankel scale and ASIA motor score （AMS）. Results Both MRI and X-ray detected following abnormal pathological changes in all patients： rupture of anterior longitudinal ligament, horizontal tear of disk, intervertebral disk hernia, compression and edema of spinal cord. The follow-up lasted for 9-32 months （ average 17.5 months ）, which showed that all patients got improvement for 1-3 scales except that one patient with Frankel A had no improvement in neurological function. Compared with AMS on admission, both AMS at two months after surgery and at final follow-up was increased significantly,with recovery rate of AMS for 44.9% and 68.1% , respectively. There found no hardware related complications such as implant loosening, defluxion or breakage. Bone fusion was found in all fixation segments.Conclusions MRI and X-ray are important examination means for hyperextension cervical spine injury combined with intervertebral disk injury. On a specified diagnosis, anterior surgical treatment should be done early and can get satisfactory recovery of spinal cord function.

关 键 词：脊髓损伤 颈椎 椎间盘 诊断 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]