颈胸段脊柱脊髓伤的诊断及前路手术治疗

目的 探讨颈胸段脊柱脊髓损伤的临床特点、诊断及颈胸段前路减压、植骨、Orion钢板内固定术的治疗作用。方法 分析26例颈胸段脊柱骨折、脱位患者的临床表现；行颈胸段前路C7、T1、C6－7或C7－T1椎体次全切除、植骨及Oron锁定型颈椎前路钢板固定术。结果 颈胸段脊柱脊髓损伤患者通常表现为C8－T1或T2相应节段脊髓神经根症状，10例伴有窦性心动过缓、8例出现低血压、7例出现Horner征等交感节刺激症状。所有患者随访3－20个月，植骨均在3－4个月内完全融合，20例脊髓神经功能有不同程度的改善，上述交感神经节刺激疾病缓解，1术后出现暂时性声音嘶哑。结论 颈胸段脊柱脊髓损伤根据其临床特点、影像学表现可确定诊断；颈胸段前路减压、植骨、Orion钢板内固定术对颈胸段脊柱脊髓损伤具有较好的疗效，Orion钢板有助于植骨节段融合、重建和稳定颈胸段脊柱。

Diagnosis of cervicothoracic junction trauma and its treatment by anterior operation

Objective　To investigate the clinical characteristics, diagnosis of cervicothoracic spine, spinal cord trauma and effect of anterior decompression, bone graft, Orion plate fixation on treatment of cervicothoracic junction trauma. Methods　The clinical characteristics of 26 cases of cervicothoracic spine and spinal cord trauma were analyzed, which were performed with anterior subtotal vertebraectomy at C7,T1, C6～7 or C7～T1 segment, bone graft and Orion anterior cervical locking plate fixation in cervicothoracic spine. Results　All cases had the relative cord or nerve root symptom of C8～T2 and some manifasted sympathetic gang irritant symptom, including 10 cases of sinus bradycardia, 8 cases of hypotension, 7 cases of Horner sign. Through 3～20 months follow-up, complete fusions of bone graft were found within 3～4 months in all cases. There were no complications of loosening or breaking of the plate and the screws. Spinal cord neurological function in 20 cases improved to different degrees. The above sympathetic gang irritant symptoms were resolved. Transient hoarse voice appeared in one case. Conclusion　The diagnosis of the injury can be confirmed by the clinical characteristics and imaging manifestation. Anterior decompression, bone graft and Orion locking plate fixation have better effect for treatment of spine and spinal cord trauma in cervicothoracic junction, which is helpful for the bone graft healing, reconstruction and stability in cervicothoracic spine.