颈椎过伸性损伤的诊断和早期死亡指标分析  

Clinical analysis of hyperextension Injury of cervical spine

作　　者：张永进[1] 何海潮[1] 吕晓强[1] 刘志英[1] 徐杰[1] 杜英勋[1] 贾连顺[2] 

机构地区：[1]温州医学院附属东阳医院骨科,东阳322100 [2]上海长征医院骨科

出　　处：《浙江医学》2010年第5期656-658,661,共4页Zhejiang Medical Journal

基　　金：2008年浙江省医药卫生科学研究基金计划（2008A163）

摘　　要：目的 探讨颈椎过伸性损伤临床表现、影像学特点及高位颈脊髓完全损伤的预后,为颈椎过伸性损伤的诊治提供依据,确认颈脊髓损伤的早期死亡指标.方法 89例颈椎过伸性损伤患者进行回顾性分析.对颈椎过伸性损伤的临床表现进行分类,统计相关影像学特点.结果 脊髓中央损伤综合症占39.32%,居首位,其中典型脊髓中央损伤综合症占16.85%,不典型脊髓中央损伤综合症占22.47%,以手部运动、感觉障碍为主占23.60%,居其次,前脊髓损伤综合症占13.48%,以上肢感觉障碍为主占12.36%,完全性脊髓损伤致四肢全瘫占3.37%,非典型Brown-Sequra征占3.37%,四肢无运动功能,但保留骶段感觉运动功能者占2.25%,颈部疼痛占2.25%.脊髓损伤性表现主要为脊髓内出血、水肿或弥漫性出血、水肿,椎前血肿、水肿、积液,椎间盘前缘及椎间盘水平裂,前纵韧带断裂,分别占65.17%、57.30%、25.84%、22.47%.25例C3、C4以上损伤中,3例为完全性脊髓损伤,均死于呼吸衰竭.结论 颈椎过伸性损伤的临床表现具有多样性,颜面部皮肤损伤、影像学变化结合临床表现特点,为颈椎过伸性损伤的诊断提供依据.高位颈脊髓完全性损伤,是颈椎过伸性损伤患者的一个早期死亡指标.Objective To review clinical manifestations, imaging features and the prognosis in hyperextension injury of cervical spine. Methods The clinical data of 89 patients with hyperextension injury of cervical spine were retrospectively analyzed in terms of clinical manifestations, imaging features and prognosisi. Results Among all clinical manifestations, central cervical spinal cord syndrome accounted for 39.32% ranking the first, including 16.85% of typical type and 22.47% of atypical type. The impediment of hand movements and sensation accounted for 23.60 % ranking the second; the anterior spinal cord syndrome accounted for 13.48%; upper extremity sensory disturbances accounted for 12.36%; complete paralysis accounted for 3.37%; atypical Brown-Sequard syndrome accounted for 3.37%. 2.25% patients lost limbs motor function while retained the sacral sensory and motor function, 2.25% patients presented only neck pain. The presentations of spinal cord injury mainly as spinal cord hemorrhage, diffuse hemorrhage or edema, prevertebral hematoma and edema or effusion, crack of intervertebral disc and rupture of anterior longitudinal ligament, accounted for 65.17%, 57.30%, 25.84% and 22.47% respectively. Spinal cord injury located above at C3 or C4 in 25 cases including 3 cases with complete spinal cord injury who died of respiratory failure. Conclusion The clinical manifestations of hyperextension injury of cervical spine are of diversity; facial skin lesions, imaging changes and clinical characteristics provide the basis of diagnosis. Complete high cervical spinal cord injury is an index for early death of hyperextension injury of cervical spine.

关 键 词：颈椎 颈椎损伤 过伸性损伤 诊断 早期死亡指标 

分 类 号：R651.2[医药卫生—外科学]