颈椎过伸性脊髓损伤节段的相关性因素研究  

Research on correlative factor of spinal segment distribution in cervical hyperextension injury

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[1] 

机构地区：[1]温州医学院附属东阳医院骨科,浙江省东阳322100

出　　处：《中华急诊医学杂志》2010年第7期761-763,共3页Chinese Journal of Emergency Medicine

基　　金：2008年浙江省医药卫生科学研究基金（2008A163）

摘　　要：目的 探讨颈椎过伸性损伤的退变性因素、损伤节段的分布及其原因.方法 温州医学院附属东阳医院89例颈椎过伸性损伤患者进行回顾性分析,统计颈椎退行性病变、T2WI相脊髓高信号的位置及颜面部外伤的位置.结果 间盘突出58例,居首位;其后依次为后纵韧带骨化（8例）、发育性椎管狭窄（7例）及椎间盘突出＋黄韧带肥厚（6例）.单节段T2WI相脊髓高信号在椎间盘水平：C2～3者4例,额部外伤1例;C3～4者12例,额部外伤10例,颧部外伤1例;CA～5者12例,额部外伤5例,额部＋颧部外伤1例,额部＋下颌部外伤1例;C5～6者11例,额部外伤3例,颧部外伤3例,下颌部外伤2例.单节段脊髓高信号位置不在椎间盘水平4例,脊髓高信号在两个不连续节段10例,脊髓高信号超过2个节段2例,脊髓高信号超过3个节段6例.结论 椎间盘突出是颈椎过伸性损伤患者最多见的退变性因素,T2WI相脊髓高信号的水平与额面部撞击的部位相关,拐点的剪切力（inflection point shear force）合并（或）颈椎过伸的前后挤压力是颈椎过伸性损伤的机制.Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows：4 cases were at C2/3, of which onesuffered the forehead trauma; 12 cases were at C3/ 4, of which 10 had the forehead trauma, and one had the zygomatic trauma; 12 cases were at C4/5, of which 5 had the forehead trauma, one had both the zygomatic and the forehead trauma, and one had both the forehead and with the lower jaw trauma; 11 cases were at CS/6,of which 3 had the forehead trauma, 3 had the zygomatic trauma, and 2 had the lower jaw trauma. The location of the spinal cord with single high signal in T2WI did not correspond with the intervertebral disc level in 4 cases. For 10 cases the high signal in T2WI was found at two discontinuous segments. For 2 cases the 1 high signal in T2WI was found at over two segments. For 6 cases the high signal in T2WI was found at over three segments. Conclusions Disc hemiation is the most common underlyding factor in cervical hyperextension injury. The spinal level with high signal in T2WI was correlative to the impacted facial site. The shear force at the inflection point with or without the anterior-posterior compression force accounted for the cervical hyperextension injury.

关 键 词：颈椎 退行性病变 过伸性损伤 损伤节段 椎体动态变化 

分 类 号：R687.3[医药卫生—骨科学]