CT扫描在环枢椎损伤诊断中的价值

目的：探讨CT扫描在环枢椎损伤中的诊断价值。方法：42例环枢椎损伤病例均行X线检查及CT扫描，采用螺旋CT薄层扫描并作二维重建。结果：42例中，环椎骨折12例，齿状突骨折24例，枢椎椎体骨折5例，单纯性环枢关节旋：转脱位1例。CT全部正确诊断，X线平片正确诊断29例（69．4％）。结论：螺旋CT能对环枢椎损伤作出全面而准确的评价，是环枢椎损伤最好的检查方法。     

寰枢椎损伤的CT诊断(附50例分析)

目的 探讨ＣＴ对寰枢椎损伤的诊断价值。方法 回顾性分析５０例寰枢椎损伤４ ＣＴ扫描资料。结果 寰椎骨折８例,齿状突骨折２４例,枢椎椎体骨折４例,枢椎椎弓骨折１１例,单纯性寰枢关节间脱位３例。ＣＴ全部诊断正确;Ｘ线平片诊断正确３４例。结论 ＣＴ能够清楚地显示寰枢椎骨折和脱位的情况,能准确确定骨折的类型和骨折的稳定性。ＣＴ是寰枢椎损伤最好的检查方法,应该常规应用。     

寰枢椎结合性骨折的临床分析

目的 总结寰枢椎结合性骨折临床特点、损伤机制和外科治疗方法。方法 对15例单纯性寰枢椎结合性骨折患者的致伤原因、并发的脊髓损伤情况、合并伤和影像学表现等进行总结，分析其损伤类型和机制。对不同的损伤类型选择不同的治疗方法，其中非手术治疗3例，手术治疗12例。对所有患者进行随访，评价并发症和预后情况。结果 寰枢椎结合性骨折占我院同期颅颈交界区损伤患者的12％(15／125)；所有的寰枢椎结合性骨折均为混合性外力机制，常见的外力形式有压缩、后伸和侧屈；5例寰枢椎结合性骨折并发有脊髓损伤，均有齿状突骨折并发寰枢椎脱位；所有患者均骨性愈合或融合，自觉症状均有改善，未发生脊髓损伤、椎动脉损伤、脑脊液漏等手术并发症。结论 寰枢椎结合性骨折常见的基本损伤机制可分为过伸 压缩机制和侧屈 压缩机制两类；寰枢椎结合性骨折并发脊髓损伤的主要机制为寰枢椎脱位继发的椎管狭窄；寰枢椎结合性骨折导致的脊柱失稳可分为寰枢关节和颈2／3关节两个节段；积极的适当的手术治疗有助于提高疗效。     

环枢椎损伤的平片与CT诊断

目的：分析环抠椎损伤的平片与CT表现，比较它们的诊断价值。方法：15例环枢椎损伤患者均行普通X线照片(包括颈椎正侧位、环枢椎张口位)及CT扫描检查结果：单纯环枢椎骨折7例，单纯脱位6例，骨折并脱位2例。X线平片正确诊断13例，误诊2例：CT全部正确诊断，CT可清楚显示环枢椎脱位、及椎体骨折部位、范围、骨性椎管的大小致畸形。结论平片及CT均是诊断环枢椎病变的重要手段。CT对显示复杂性骨折及骨性椎管形态的改变较平片有明显优势。     

CT扫描在环枢椎损伤诊断中的价值

目的 :探讨CT扫描在环枢椎损伤中的诊断价值。方法 :3 7例环枢椎损伤病例均行X线检查及CT扫描 ,采用螺旋CT薄层扫描并作二维重建。结果 :3 7例中 ,环椎骨折 5例 ,齿状突骨折 18例 ,枢椎椎弓根骨折 11例 ,枢椎椎体骨折 2例 ,单纯性环枢关节旋转脱位 1例。CT全部正确诊断 ,X线平片正确诊断 2 6例 ( 70 .2 %)。结论 :螺旋CT能对环枢椎损伤作出全面而准确的评价 ,是环枢椎损伤最好的检查方法     

上颈椎损伤的CT诊断

目的探讨CT对上颈椎损伤的诊断价值.方法19例上颈椎损伤患者,男14例,女5例,年龄9～49岁,平均23岁.采用螺旋CT行薄层扫描,必要时作三维表面重建,或多平面重建.结果椎体骨折13例,环枢关节脱位10例,其中环齿关节脱位7例,单纯枢椎旋转脱位2例,另1例为环椎旋转脱位合并环枢椎嵌插交锁固定.结论CT能明确显示上颈椎骨折、脱位,椎管及脊髓损伤情况,有助于临床及时准确地制订治疗方案.     

创伤性寰枢椎不稳的几个问题

创伤性寰枢椎不稳可导致脊髓受压甚至患者死亡。不稳的原因是寰枢椎和齿状突骨折及寰横韧带撕裂。本组报告52例．其中33例为齿状突骨折，8例寰枢爆炸性骨折，4例枢椎弓骨折，7例韧带损伤及1例寰枕脱位。新鲜损伤采用非手术治疗，陈旧性者则行寰椎后弓切除和枕颈融合术，或单行枕颈融合术，本文就其临床和X线诊断作了讨论。     

16层螺旋CT重建技术在寰枢椎损伤中的诊断价值

目的:探讨16层螺旋CT及重建技术在寰枢椎损伤中的诊断价值。方法:回顾性分析我院33例寰枢椎损伤患者的16层螺旋CT资料。结果:33例寰枢椎损伤中12例为多处骨折,4例单纯性寰枢关节半脱位,C1骨折13例共17处,C2骨折16例24处,C2齿状突Ⅱ型骨折致寰枢椎脱位6例。轴位CT、多平面重建(MPR)、曲面重建(CPR)、容积再现(VRT)显示单纯性寰枢椎关节脱位3、4、4、4处以及C1骨折17、16、17、16处以及C2骨折22、24、24、19处以及齿状突Ⅱ型骨折致寰枢椎脱位5、6、6、6处。结论:16层螺旋CT扫描和三维重建,可清晰显示寰枢椎骨折及脱位情况,可作为寰枢椎损伤检查的首选。     

枕寰枢复合体创伤的影像学诊断

目的:探讨枕寰枢复合体(C_0-C_1-C_2)创伤的影像学诊断。方法:回顾性分析40例枕寰枢复合体创伤的X线、三维CT及MRI表现。结果:X线平片发现枕寰枢复合体骨折共15例,寰枢关节脱位7例,枢椎滑脱2例。三维CT发现枕寰枢复合体骨折28例,骨折合并寰枢关节脱位10例,寰枕关节半脱位5例,寰枢关节无骨折型脱位或半脱位8例。X线、CT检查阴性4例。MRI检查示28例枕寰枢骨折患者椎体有骨髓挫伤水肿表现,18例延髓或颈髓形态或信号异常,15例椎旁软组织及韧带损伤。结论:联合X线、三维CT及MRI诊断枕寰枢复合体创伤,可提高诊断准确性,为临床治疗提供依据。     

老年上颈椎损伤的临床特点与治疗

目的 探讨老年上颈椎损伤的临床特点与治疗方法.方法 回顾性分析我科2003年1月-2007年12月间收治的>60岁上颈椎骨折脱位患者28例的临床资料,其中男20例,女8例;年龄60～86岁,平均68.1岁.致伤原因:跌伤16例,交通伤8例,高处坠落伤4例.寰椎骨折5例;枢椎骨折15例,其中齿状突骨折8例,C2椎弓骨折6例,C2椎体骨折1例;寰枢椎损伤伴下颈椎损伤5例;寰枢椎同时损伤2例,其中齿状突骨折伴寰椎侧块骨折1例,齿状突骨折伴寰椎前弓骨折1例;寰枢关节脱位1例.并发脊髓损伤4例.保守治疗8例,开放手术治疗8例,微创经皮手术治疗12例.结果 平均住院时间比较,保守组与传统手术组间差异无统计学意义(P>0.05),而微创经皮组短于保守组与传统手术组(P<0.05).保守治疗组2例死亡,开放手术组1例死亡,其余25例均获得随访,随访时间9～56个月,平均16.8个月.保守治疗组患者满意率为50%,开放手术组为72%,微创手术组为75%.保守治疗组中4例发生并发症,传统手术组3例,微创手术组2例.结论 老年上颈椎损伤发生率较高,其损伤特点以低能量暴力为主,损伤类型以齿状突骨折最常见,具有脊髓损伤发生率低、漏诊率高等特点.在排除手术禁忌证的情况下,手术治疗特别是微创手术可取得较好的临床疗效.     

Significant new observations on cervical spine trauma.

The results of a computer analysis of 399 patients with documented fractures and/or dislocations of the cervical spine are summarized. Vertebral arch fractures were present in half of all patients with radiographic evidence of cervical spine trauma. Two-thirds of the patients had two or more injuries. Isolated disk injuries were rare and, when present, were characterized by a vacuum sign. The dens fracture, with or without atlantoaxial dislocation, was rarely associated with injury elsewhere in the cervical spine. The study suggests that the routine five-film cervical spine examination is inadequate to detect the most common traumatic lesions. Thus vertebral arch views (pillar views) should be obtained if there is evidence to suggest hyperextension as the mechanism of injury. In addition, the study underscores the importance of aggressively searching for multiple abnormalities.     

The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis

The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.     

Fractures of the atlas vertebra

In a series of 400 patients with fractures and dislocations of the cervical spine, 5% involved the atlas. There are nearly equal numbers of fractures of the posterior arch, bursting fractures of Jefferson, and horizontal fractures of the anterior arch. Atlas fractures are rarely associated with neurologic deficit, but they may be the cause of severe pain. Hypotheses concerning the mechanism of injury in each type of fracture are discussed. The characteristic roentgenographic findings and the differential diagnoses are reviewed.     

"徒手法"个体化颈椎椎弓根螺钉技术治疗上颈椎骨折脱位

目的 探讨应用颈椎椎弓根钉治疗上颈椎骨折及脱位的临床效果.方法 2006年9月-2009年1月,应用颈椎椎弓根钉治疗的上颈椎骨折或脱位的患者15例.其中男11例,女4例;年龄18～60岁,平均41.2岁.寰椎骨折脱位5例,枢椎骨折脱位3例,齿状突陈旧骨折不愈合1例,C2,3骨折脱位2例,无骨折寰枢椎失稳4例.临床主要症状为颈部疼痛或伴有四肢麻木无力、步态不稳.患者术前均行Halo架牵引试行复位.所有患者均采用颈椎椎弓根钉固定并植骨融合,根据术前X线片及CT个体化确定入钉点及置钉角度,徒手法钻出骨性通道,选用22～26 mm长的Vertex或Summit钛金属螺钉固定,并行后路椎板间自体或同种异体骨植骨融合.术后1～2 d佩戴颈托离床活动.结果 本组15例共置入颈椎椎弓根螺钉64枚,均未发生椎动脉和脊髓损伤,无脑脊液漏.术后行X线正、侧位片和CT检查证实损伤节段复位满意、螺钉位置良好.术后疼痛症状基本消失,神经症状较术前有不同程度的改善.14例患者获得随访,时间12～36个月,患者颈椎序列良好,均获得骨性融合,未发生螺钉及钛棒的松动、脱出及折断.神经损伤症状较术前明显改善.结论 颈椎椎弓根钉是颈椎后路手术中坚强的固定方法,只要掌握手术操作技巧,严格个体化置钉,颈椎椎弓根钉具有固定可靠、术后并发症少、融合率高等优势,具有良好的临床疗效.

Abstract：

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures),three with axis fracture and dislocation,one with dens fractures plus nonunion,two with C2,3 fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation,the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22-26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1-2 after operation.Results A total of 64 cervical pedicle screws were implanted in all 15 patients,with no vertebral artery injury,spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12-36 months,which showed bony fusion,with no looseness or breakage of the screws.Neurologic impairment was improved in all patients,with no complications associated with the cervical pedicle screw.Conclusions Cervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.     

Evaluation of vertebral artery injury from ballistic trauma to the neck

This study was conducted to assess the likelihood of vertebral artery injury after gunshot wounds to the neck in patients without and with fracture of the cervical spine. All patients presenting to the emergency department with cervical gunshot wounds were evaluated with cervical spine radiographs; if a fracture was suspected, a computed tomographic scan was obtained. All patients with cervical gunshot wounds underwent selective angiography of the cervical vessels. The images were retrospectively reviewed by three American Board of Radiology boardcertified radiologists, assessing for the presence of fracture and vascular injury.Of the 50 patients presenting with ballistic trauma to the neck, 21 patients had sustained a cervical spine fracture; of these, 9 patients had a vertebral artery injury. Only 1 of the 29 patients without a cervical spine fracture had vascular damage. In that patient, however, the bullet was lodged between the transverse processes of the cervical vertebrae at the level of vascular injury.In the absence of a cervical spine fracture or evidence that the missilés trajectory has crossed the vertebral artery, injury to the vertebral artery is unlikely after a gunshot wound to the neck. A computed tomographic scan of the neck may help in tailoring the angiogram performed after ballistic injury.     

Use of CAT Scan for a Cervical Vertebral Arch Fracture

In brief: Cervical spine injuries are difficult to diagnose accurately with standard x-rays because the bony structures overlap one another. However, computerized axial tomography (CAT scanning) clearly shows the vertebral relationships. A CAT scan of the C-6 region of a 16-year-old high school running back who sustained an injury to the cervical spine revealed a fracture of the right vertebral arch that could not be seen on plain x-rays. The author says that because cervical and intracranial injuries can result in death or paralysis, players who experience numbness, tingling, paresthesia, and/or paralysis should be removed from sports activity.     

Lateral hyperflexion injuries of the cervical spine

Injuries secondary to lateral hyperflexion forces are an unusual and commonly unrecognized entity. Patients demonstrate a wide range of symptoms and physical findings and may incur years of chronic pain if the lesion is not appreciated. Careful evaluation of historical evidence, mechanism of injury, and physical examination supplements interpretation of frontal and oblique radiographs of the entire cervical spine. Because the majority of patients reviewed sustained more than one fracture, careful scrutiny, especially of the vertebral arch, is recommended.Presented as an exhibit at the American Roentgen Ray Society Meeting, Boston, Massachusetts, September, 1977     

无脊髓损伤的颈椎骨折脱位临床研究

目的探讨无脊髓损伤的颈椎骨折脱位的发病机制及手术治疗方法。方法 32例无脊髓损伤的颈椎骨折或骨折脱位,其中新鲜损伤26例,陈旧性损伤6例。其中28例手术治疗,4例非手术治疗。结果术后全部病例均获随访观察,26例完全恢复,6例残留手指麻木和局部不适。植骨在3个月内牢固融合。颈椎椎间高度、生理曲度维持良好,无断钉及断板等并发症。结论对于无脊髓损伤的颈椎骨折脱位发病机制特殊,手术治疗可使不稳的颈椎获得即刻的稳定性,有效地防止脊髓的继发性损伤。