《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (08): 978-981.

• 特稿 • 上一篇    下一篇

颈椎骨折脱位并发前脊髓综合征32 例分析

张军军1a，张艳1b，刘志旺1c，卢占斌1a，王立功1a，周钱宏1a，陈先1a，黄玉国1a   

  1. 1.河北省唐山市第二医院，a.脊柱三科，b.院办室，c.医务科，河北唐山市063000。作者简介：张军军(1974-)，男，汉族，河北沧县人，硕士，副主任医师，主要研究方向：脊柱外科。
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-08-25 发布日期:2015-08-25

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

ZHANG Jun- jun1a, ZHANG Yan1b, LIU Zhi-wang1c, LU Zhan- bin1a, WANG Li-gong1a, ZHOU Qian-hong1a, CHEN Xian1a, HUANG Yu-guo1a   

  1. 1. a. the Third Department of Spine Surgery, b. the Hospital Office, c. the Medical Department, the Second Hospital of Tangshan, Tangshan, Hebei 063000, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-08-25 Online:2015-08-25

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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。

关键词: 颈椎, 前脊髓综合征, 过屈损伤

Abstract: 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.

Key words: cervical vertebra, anterior spinal cord syndrome, hyperflexion injury