无脊髓损伤颈椎骨折脱位临床治疗.docVIP

无脊髓损伤颈椎骨折脱位临床治疗【摘要】 目的 探讨无脊髓损伤颈椎骨折脱位的临床治疗。方法 1998年7月～2010年12月本院共收治46例无脊髓损伤的颈椎骨折或骨折脱位患者，新鲜损伤43例，陈旧性损伤3例，其中40例手术治疗，6例保守治疗。结果 本组病例均获得随访，时间12～36个月，平均20.3个月，症状均获得改善，36例完全恢复，7例残留手指麻木，3例颈椎旋转活动受限,颈椎椎间高度、生理曲度维持良好。结论 对于无脊髓损伤的稳定性上颈椎骨折脱位行牵引、制动、复位和固定；而不稳定性上颈椎骨折脱位应选择手术治疗。对于无脊髓损伤的下颈椎骨折脱位宜早期手术治疗，尽早复位及固定并行融合手术，手术方式以前路手术为主，有小关节绞锁复位困难时要先后路解锁，再前路固定融合。重建颈椎稳定性，对防止继发性脊髓损伤起极其重要的作用。? 【关键词】 颈椎； 骨折脱位； 无脊髓损伤； 临床治疗?? The clinical treatment of cervical spine fracture and dislocation without spinal cord injury ?GAO Bin.The First Hospital Of Liangshan,Liangshan 615000,China?? 【Abstract】 Objective To select the methods of treatment for cervical spinal fractures and dislocations.Methods Fourty six cases of cervical spinal fractures and dislocations without spinal cord injury between July 1998 and December 2010 were reviewed,including 43 cases of fresh injury and 3 cases of old injury.40 cases were treated with surgical treatment.6 cases were treated with conservative treatment.Results All cases were followed-up from 12 to 36 months,with the mean of 20.3 months.Clinical manifestations were improved in all cases and 36 cases got complete remission.7 cases still felt finger-numbness.3 cases felt rotational restriction.Intervertebral heights and physiologic curves were kept well.Conclusion For stable superior cervical spinal fractures and dislocation without spinal cord injury were treated with conservative treatment.Instable was treated by surgery.Anterior approach was preferred to inferior cervical spinal fractures and dislocation without spinal cord injury.Through anterior approach,it was feasible to get complete decompression,good reduction and excellent maintenance of intervertebral heights and physiologic curves.More important,cervical spine could be stabilized immediately and secondary injury to spinal cord would be prevented.? 【Key words】 Cervical spine； Fractures and dislocations； Without spinal cord injuries； Clinical treatment ?? 头颈部遭受外力后引起颈椎骨折脱位和脊髓损伤较常见，颈椎骨折脱位常导致颈脊髓损伤而造成四肢感