颈椎骨折脱位并发前脊髓综合征32例分析  

Cervical Fracture Dislocation Combined with Anterior Spinal Cord Syndrome:32 Cases Report

作　　者：张军军[1] 张艳[2] 刘志旺[3] 卢占斌[1] 王立功[1] 周钱宏[1] 陈先[1] 黄玉国[1] 

机构地区：[1]河北省唐山市第二医院脊柱三科,河北唐山市063000 [2]河北省唐山市第二医院院办室,河北唐山市063000 [3]河北省唐山市第二医院医务科,河北唐山市063000

出　　处：《中国康复理论与实践》2015年第8期978-981,共4页Chinese Journal of Rehabilitation Theory and Practice

基　　金：2014年度唐山市科技计划自筹经费计划项目(No.14130239a)

摘　　要：目的探讨颈椎骨折脱位并发前脊髓综合征（ASCS）的发病机制、病理特点及诊疗策略。方法总结2012年1月~2014年9月本院收治的32例颈椎骨折脱位并发ASCS患者的资料,对受伤机制、病理特点进行综合分析。所有患者均采用手术治疗。根据不同损伤特点采用单纯前路手术或前后路联合手术。结果所有患者均成功实施手术。发病机制：过屈型损伤22例（68.75%）,垂直打击5例（15.62%）,过伸型损伤1例（3.12%）,混合因素致伤4例（12.5%）。病理特点：单纯前脱位4例（12.5%）,骨折并发前脱位28例（87.5%）。诊断：入院初步诊断时仅8例成功诊断为ASCS,其余24例皆笼统为脊髓损伤。结论 ASCS并非少见,颈椎屈曲型损伤为其主要受伤机制。前脱位和骨折并发前脱位较常见,严格查体辅助CT、MRI有助于明确诊断。根据损伤机制,前路或前后联合入路手术是适当的治疗方法。Objective To study the mechanism,pathology,diagnosis and manage strategy of cervical fracture dislocation combined with anterior spinal cord syndrome（ASCS）.Methods 32 cases of cervical fracture dislocation combined with ASCS from January 2012 to September 2014 were summarized.The mechanisms of injury and pathological characteristics were analyzed.All of them received surgical treatment.Anterior approach or anterior approach combined with posterior approach was chosen according to the characteristics of injury.Results All surgical treatments were successfully performed.There were 22 cases（68.75%） with hyperflexion,5 cases（15.62%） with vertical hit,1 case（3.12%） with hyperextension and 4 cases（12.5%） with multiple reasons.There were 4 cases（12.5%） with simple anterior dislocation,28 cases（87.5%） with fracture combined with anterior dislocation.Only 8 cases were successfully diagnosed as ASCS,and the others（24 cases） were generally defined as spinal cord injury.Conclusion ASCS is not so rare.Hyperflexion injury is the most common mechanism.Anterior dislocation and fracture combined with anterior dislocation are the general types of pathology.Conscientious physical examination with CT and MRI can facilitate the diagnosis.Anterior approach or combined with posterior approach could be selected according to injury mechanism.

关 键 词：颈椎 前脊髓综合征 过屈损伤 

分 类 号：R651.2[医药卫生—外科学]