成人无骨折脱位型颈髓损伤的临床诊疗特点及亟需关注的重点问题  

Cervical spinal cord injury without fracture-dislocation in adults:clinical diagnosis and treatment characteristics and key issues requiring urgent attention

作　　者：李庆达 弓伊宁 贺宝荣[1] Li Qingda;Gong Yining;He Baorong(Department of Spinal Surgery,Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054

出　　处：《中华创伤杂志》2024年第8期673-678,共6页Chinese Journal of Trauma

基　　金：陕西省重点研发计划项目(2023-ZDLSF-03)。

摘　　要：成人无骨折脱位型颈髓损伤(CSCIWFD)是指颈椎受到外力作用而导致脊髓受损,但颈椎本身在X线片或CT检查中未见骨折或脱位。CSCIWFD由于是机体的二次打击伤害,脊髓水肿和韧带血肿形成压迫,神经功能受损的表现可能在伤后几天才出现,常导致不完全或完全性瘫痪,引发慢性疼痛和劳动力丧失。若在损伤早期诊疗不当,可能加重迟发性神经功能障碍,对患者生活质量和预期寿命造成严重影响。目前,CSCIWFD的诊疗存在临床表现轻重不一、损伤机制复杂、漏诊和误诊率高、治疗方法争议大等问题,应从规范化诊疗流程、多方法结合检查及制订个体化治疗方案等方面,提高诊断准确性和治疗效果,最大限度改善患者预后。为此,笔者就CSCIWFD的临床诊疗特点及亟需关注的重点问题进行探讨,为临床诊疗提供参考。Cervical spinal cord injury without fracture-dislocation(CSCIWFD)in adults is a condition in which the cervical spinal cord is injured by an external force to the cervical spine,but the cervical spine itself is not fractured or dislocated on X-ray films or CT.Since CSCIWFD is caused by a second-strike injury to the body,with a compression formed by spinal cord edema and ligamentous hematoma,signs of neurological function impairment that may not appear until several days after the injury which often cause incomplete or complete paralysis,thus resulting in chronic pain and loss of work.Inadequate treatment in the early stages of injury can exacerbate delayed neurological deficits,seriously offecting the patients'quality of life and life expectancy.Currently,there are problems related to the diagnosis and treatment of CSCIWFD,such as the of clinical manifestations varying severity,complex mechanism of injury,high rates of missed diagnosis and misdiagnosis,and controversial treatment methods.Besides,standardized diagnostic and treatment regimens,multimodal diagnostic approach,and individualized treatment plans should be adopted to improve the diagnostic accuracy and therapeutic effects and maximize the prognosis of patients.In this regard,the authors discussed the clinical characteristics and key issues requiring urgent attention in the diagnosis and treatment of CSCIWFD to provide a reference for clinical diagnosis and treatment.

关 键 词：脊柱骨折 脱位 脊髓损伤 诊断 鉴别 

分 类 号：R651.2[医药卫生—外科学]