无骨折脱位型颈髓损伤的诊治

①目的　探讨无骨折脱位型颈髓损伤的病因、临床特点、诊断和治疗。②方法　对 4 2例无骨折脱位型颈髓损伤病人进行回顾性分析 ,其中行颈椎正侧位X线片检查 4 2例 ,CT扫描 2 5例 ,MRI检查 19例 ;手术治疗31例 ,颈椎前路椎间盘切除植骨融合术 4例 ,后路单开门颈椎管扩大成形术 2 7例。③结果　颈髓损伤组颈椎管狭窄的发生率显著高于对照组 (χ2 =13.0 9,P <0 .0 0 5 )。MRI检查 19例提示颈髓损伤存在脊髓水肿、髓内出血和脊髓挫裂伤 3种形式。伤后 14d内手术者疗效优于晚期手术者。④结论　发育性或退变性颈椎管狭窄、颈椎间盘突出、后纵韧带骨化、颈椎失稳是该病的主要病理解剖基础。临床Frankel分级与MRI检查对判断预后有重要意义。对X线片或CT扫描示无骨折脱位型颈髓损伤病人 ,应尽早行MRI检查 ,争取 14d内手术。

THE DIAGNOSIS AND TREATMENT OF CERVICAL SPINAL CORD INJURY WITHOUT FRACTURE AND DISLOCATION

Objective To analyze the causes, clinical manifestations, diagnosis and treatment of cervical spinal cord injury without fracture and dislocation.\ Methods\ Forty two cases with the trauma were studied retrospectively. Cervical lateral and AP X ray films were taken in 42 cases, CT scan in 25 cases and MRI 19 cases. 31 cases received operative treatment. Of which, anterior cervical discectomy with fusion (ACDF) was done in 4 cases, and posterior cervical expansive mono open door laminoplasty (PCEML), 27 cases. \ Results\ The incidence of cervical spinal canal stenosis in the injured group was significantly higher than that of the normal control. MRI scan of 19 cases showed that there was 3 main types of cervical spinal cord injury: spinal cord edema, intramedullary hemorrhage and spinal cord laceration. Operations done within 2 weeks after trauma had a better effect than that of later ones. \ Conclusion\ Developmental or degenerative cervical spinal canal stenosis, cervical intervertebral disc protrusion, OPLL, cervical vertebrae instability are the main pathoanatomical basis of the lesion of this kind. Clinical Frankle grading and MRI scan have an important value in predicting the prognosis. MRI examination should be given as early as possible to the patients whose X ray film and CT scan show no fracture and dislocation. Operations should be done within 2 weeks.