重型颅脑损伤合并寰枢椎半脱位的诊断与治疗

目的探讨重型颅脑损伤合并寰枢椎半脱位的诊断和治疗方法。方法重型颅脑损伤137例患者中合并寰枢椎半脱位者17例。每例患者均行颅脑和寰枢椎CT扫描，必要时加做寰枢椎CT三维重建或MRI检查。在积极治疗颅脑损伤同时，均予以颈同固定制动、颌枕吊带或颅环弓牵引治疗。结果17例重型颅脑损伤合并寰枢椎半脱位患者经治疗后12例神志转清，5例植物生存。2例有脊髓损伤者完全恢复。无1例因寰枢椎半脱位而导致呼吸骤停或猝死，CT复查寰枢椎结构恢复正常。结论对重型颅脑损伤患者在颅脑伤诊治的同时，应常规行寰枢椎CT检查，以明确诊断，早期治疗，能有效预防并发症，改善预后。

Diagnosis and Treatment of Severe Traumatic Brain Injury Accompanied with Atlanto-axial Subluxation

Objective To study the diagnosis and treatment of severe traumatic brain injury accompanied with Atlanto- axial subluxation. Methods There was atlanto- axial subluxation in 17 of 137 patients with severe traumatic brain injury treated in our hospital from August, 2003 to October, 2004. CT examination of head and atlanto- axial spine and three- dimension CT reconstruction or MRI were performed if necessary in 17 patients with severe brain injuries accompanied with atlanto- axial subluxation, which was treated by stiff collar, jaw- occipital sling or skull traction while the brain injuries were routinely treated. Results Of the 17 patients with severe traumatic brain injury accompanied with atlanto- axial subluxation, 12 recovered their consciousness, 5 vegetatively survived. Two patients with spinal cord injury got perfect recovery. The sudden ceasing of respiration or sudden death induced by atlanto- axial subluxation did not occur in all the patients. Anatomic structure of atlanto- axial spines in all the patients returned to normal on CT images in all the patients. Conclusions CT examination of atlanto- axial spines should be routinely carried out during treating cerebral brain injury in order to diagnose accurately and to treat atlanto- axial subluxation as soon as possible in the patients with severe brain injury. Early diagnosis and treatmentn of the atlanto- axial subluxation are very important to prevention of the complications and improvement of the patients' prognosis.