颈椎无放射影像异常脊髓损伤的早期诊断和治疗

目的：探讨颈椎无放射影像异常脊髓损伤(SCIWORA)的早期诊断和治疗方法。方法：12例SCIWORA患入院后进行仔细的物理学检查了解神经系统定位体征，判定脊髓损伤平面，所有患常规作X线和CT检查，了解椎管指数，同时作MRI成像，了解颈椎间盘有无突出及脊髓损伤情况，从而作出早期诊断。对8例椎问盘突出行前路减压 植骨 颈椎前路钢板内固定。4例保守治疗。结果：1)75%患存在颈椎管狭窄；2)早期通过物理学检查确定的脊髓受损平面与MRI检查基本相似，MRI可进一步了解脊髓压迫和损伤的形态学改变；3)手术治疗8例神经功能大部分明显改善，非手术治疗改善不明显。结论：1)：椎管狭窄是SCIWORA重要的病理学基础；2)早期的物理学检查对SCIWORA的早期诊断与MRI检查一样重要；3)手术治疗是较好的治疗方法。

Early dignosis and treatment of cervial spinal cord injury without fracture and dislocation

Objective:To explore the early dignosis and treatment of cervial spinal cord injury without radiographic abnormalities(SCIWORA).Methods:12 cases of such injury were carefully physical tested after inhibitition to locate the injuried spinal levels,the conventionl radiography and CT scan revealed the index of cervial canal,in the meanwhile,MRI examination indicated wheather the disc protrusion or spine injury,then the early dignosis were achieved.Anterior decompression was carried out in eight cases with disc herniation,conservative treatment was carried in four cases.Results:(1)75 percent of cases were associated with spinal canal stenosis;(2)The spinal injury levels deceived by early physical test were the same as spinal injury levels by MRI,the latter can reveal the morphology of the spinal cord;(3)The spinal cord function of 8 cases experienced surgical treatment markly improved,there were no change within the conservative cases.Conclusion:(1)The spinal canal stenosis is the important pathology base of SCIWORA;(2)Physical test is as important as MRI in the early diagnosis;(3)Surgical treatment is superior to the conservative treatment on outcome.