上颈椎损伤的早期诊断与治疗

目的：探讨上颈椎损伤的早期诊断方法和治疗措施。方法：回顾分析2000年1月至2008年7月间收治住院的上颈椎损伤患者35例临床资料，其中寰椎骨折6例，枢椎骨折24例，无骨折的寰枢关节脱位5例。除3例陈旧性齿状突骨折和2例陈旧性寰枢关节脱位外，其余为新鲜损伤。评价其早期诊治方法及其预后。结果：早期漏诊6例，35例患者X线检查后均需结合CT或MRI检查完善诊断及分型。手术治疗18例，其中5例为齿状突骨折早期保守治疗后改手术治疗，2例为漏诊的陈旧性寰枢关节脱位。非手术治愈16例，其中3例齿状突骨折Ⅲ型畸形愈合。1例复合性损伤患者住院3月后诊断出寰枢关节脱位出院。33例得到4～38个月随访。随访的33例患者中，骨折患者均愈合，4例寰枢关节脱位患者脱位整复，上颈椎稳定性均维持良好，神经功能改善。结论：重视上颈椎损伤患者影像检查方法早期合理的分步选择与充分利用，避免漏诊。治疗上，积极地整复骨折与脱位，尽早恢复上颈椎的稳定性。

The Early Diagnosis and Treatment of Upper Cervical Spine Trauma

Objective：To discuss the early diagnostic methods and treatment of trauma of upper cervical spine. Meth- ods：A total of 35 cases of injury of upper cervical spine from January in 2000 to July in 2008 were retrospectively analyzed. Among the 35 cases,6 were atlas fractures, 24 fractures of axis, and 5 atlantoaxial dislocations without fractures. Except 3 with old dens fractures and 2 with old atlantoaxial dislocations, the others were acute injuries. The early diagno- sis and treatment and prognosis were evaluated. Results ： Six cases were misdiagnosed. Thirty-five cases had X-ray examination followed by CT or MRI scanning in order to clarify the diagnosis and classification. Eighteen cases had surgical treatments,including 5 patients with dens fractures which had surgical treatments after early conservative treatments, and 2 patients with old atlantoaxial dislocations who were missed early diagnosis, 16 cases were cured by conservative treatments including 3 cases with dens fractures type Ⅲ in malunion. One patient with compound injury had been in hos- pital for 3 months and was discharged when the diagnosis of atlantoaxial dislocation was clear. Thirty-three cases were followed up for 4-38 months. Among the 33 cases,all fractures healed,4 atlantoaxial dislocations were reduced,the sta- bility of upper cervical spine were maintained good,and the functions of nerves became better. Conclusion： In order to avoid missing diagnosis,the methods of imaging examination of the upper cervical spine should be selected early,reasonably step by step and properly. In the treatment,fractures and dislocations should be reduced,and the stability of the upper cervical spine should he restored as early as possible.