外伤性无骨折脱位型颈髓损伤的诊断与早期处理  

Diagnosis and early management of cervical spinal cord injury without fracture or dislocation

作　　者：徐林[1] 洪毅[1] 易斌[1] 唐涛[2] 乔晓红 

机构地区：[1]北京医科大学人民医院骨神经科,北京市100034 [2]中国康复研究中心骨科 [3]山西省吕梁地区中心医院骨科

出　　处：《中国创伤骨科杂志》1999年第1期40-42,共3页

摘　　要：目的 探讨成人外伤性无骨折脱位型颈髓损伤的诊断与治疗特点。方法 56例患者平均54岁,损伤平面分布于C_2-C_8脊髓节段,完全性脊髓损伤11例;不完全性脊髓损伤45例。术前行颈椎X线平片、CT、MRI检查。先行颈部制动,酌情行前路或后路手术,并给予脱水剂、激素、神经营养药物等。结果 CT阳性检出率为79.17％;MRI为90.38％,可明确脊髓的病理状况及脊髓以外软组织的病理变化。根据接受治疗的方法和时间分组对比,显示不同的治疗效果。结论 MRI对于外伤性无骨折脱位型颈髓损伤的诊断具有优越性,可以显示脊髓损伤后脊髓及周围软组织的各种改变。应根据脊髓损伤表现及变化和MRI显示脊髓的病理状况选择治疗方法,对于有脊髓压迫的病例最好在1周内手术治疗。Objective To discuss the diagnostic and therapeutic characteristics of cervical spinal cord injury without fracture or dislocation by analysis of a group of adult patients. Methods An over 3- year follow - up group of 56 patients, 24 males and 32 females with average age 54 (21 - 73) were treated from 1991 . There were 11 cases of complete spinal cord injury and 45 incomplete. Among the incomplete cases, there were 29 presented as central spinal cord syndrome: 10 as anterior spinal cord syndrome, 3 as Brown-Sequard syndrome and 3 as posterior spinal cord injury. Cervical plain roentgenograms,CT, and MRJ were adopted to all the patients. The operative methods included anterior and posterior approach. The conservative methods included cervical cast, dehydration a-gents, steroid, and neuro - nutrition agents. Results Pathological changes of spinal cord and soft tissue can be confirmed by both CT and MRI. The positive rate is 79. 17% of CT and 90.38% of MRI. The variation among groups which were divided by therapeutic methods and initial time showes the unequal results. Conclusion MRI is the best diagnostic method. The management selection must be according to the clinical manifestation and MRI. Operation would be adopted in 1 week to the patients who presented compression of spinal cord.

关 键 词：颈髓损伤 无骨折脱位 诊断 早期处理 

分 类 号：R651.2[医药卫生—外科学] R684.7[医药卫生—临床医学]