颈椎单侧关节突交锁损伤机制与临床诊治

目的 研究颈椎单侧关节突交锁的损伤机制及临床诊治。方法 两具新鲜成人颈椎标本,采用ＣＭＴ４１０４型电子多功能试验机,分别在侧屈旋转和前屈旋转载荷下模拟颈椎小关节突交锁。并对１１例颈椎单侧关节突交锁患者的诊治情况进行分析。结果 颈椎在侧屈１１７０Ｎ、扭转１５０Ｎ,前屈２０００Ｎ、扭转１２０Ｎ的载荷下均可导致单侧小关节突交锁。但前者比后者容易发生,所需的暴力较小,伴随的损伤较轻。１１例患者中,误诊２     

儿童颈椎损伤:X线表现

作者回顾性地研究了236例颈椎损伤病人,其中青春期前组9例,男5例,女4例,年龄1-7岁。青春期组48例,男31例,女17例,年龄12-19岁。损伤原因为交通事故与坠伤。青春期前组9例中,损伤类型包括C_1的椎体与侧块的及后软骨结合骨折(Jefferson骨折),C_1椎弓骨折,枢椎齿突骨折(齿突骨骺分离),C_2双侧椎弓根骨折,C_2一侧椎板骨折,C_(1-2)后韧带破裂,C_(1-2)旋转脱位,C_5经椎体与侧块的及后软骨结合骨折,C_(6-7)完全脱位无骨折。作者指出,婴儿与儿童颈椎大小与成人不同,8岁时达成人形态,主要软骨结合3～6岁间闭合。小于7岁的幼儿,寰枢椎损伤较常见(7/9),下颈部损伤不常见(2/9),易与严重外伤合并存在,此种病例的X线征象不如临床表现严重。青春期组损伤均等地分布于上下颈椎,类似于成人。7岁以下儿童颈椎骨折的特征通常为骨     

螺旋CT三维成像在颈椎损伤病变中的应用

目的 探讨螺旋CT三维成像（MPR、SSD）在颈椎损伤中的应用价值。材料与方法 经X线和/或螺旋CT证实的颈椎损伤15例,行螺旋CT扫描,并作MPR和SSD成像,13例扫描参数为层厚3mm,床速4.5mm/s,重建间距1.5mm;2例为层厚5mm,床速5mm/s,重建间距2mm,SSD最低阈值选择150～180。结果 椎体及附件骨折10例,其中6例伴环齿关节脱位,1例椎体滑脱。椎体旋转脱位4例,成角滑脱1例。15例中3例椎管狭窄并硬脊膜受压。MPR结合轴位图像可完全明确骨折、脱位及椎管情况。SSD对颈椎表现骨折、椎体旋转及成角脱位显示良好,立体感强,但对椎体内骨裂或骨折、椎管内病变显示差。结论 颈椎损伤应首选CT检查。轴位图像、MPR及SSD联合应用,能明确病变性质,立体、直观、多方位提供临床医师所需信息,有利于治疗方案的选择。     

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.     

轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位的诊治

目的总结轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位的诊治经验,以提高对其的认识和疗效。方法回顾性分析2012年1月—2017年12月海军军医大学附属公利医院骨科收治的25例轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位患者临床资料,男性14例,女性11例;年龄20~71岁,平均48.2岁。颅脑损伤9例行手术治疗,16例行非手术治疗;颈椎骨折10例行非手术治疗,13例单独行颈椎手术,2例一期颅颈联合手术。出院时进行格拉斯哥预后评分(GOS评分),术后门诊随访X线片或CT片评价颈椎骨折愈合情况。结果出院时GOS V级20例,IV级4例,I级1例。随访12~48个月,平均24.5个月,复查颈椎X线片或CT示骨折愈合良好。结论颅脑损伤患者常规颈椎CT扫描有助于上颈椎损伤的早期诊断。上颈椎不稳定骨折在病情允许下尽早手术,可减少并发症的发生。     

颈椎间盘突出症停飞一例

一、临床资料患者男性,汉族,38岁,歼7飞行员,飞行总时间为2 32 0h。患者自诉2 0 0 2年12月初,无明显诱因出现颈部疼痛伴头晕、头痛、双上肢放射痛,右上肢无力。颈椎X线片示:颈4椎体后下角增生后突,颈5 6椎间隙变窄。颈椎CT示:颈5 6椎间盘突出。2 0 0 2年12月、2 0 0 3年2月两次在我科住院治疗,诊断为:颈椎间盘突出症(C5 6) ,给予颈部手法、牵引、颈椎旋转复位、中药热敷等治疗,好转后出院。飞行结论:飞行暂不合格,地面观察2个月。2 0 0 3年7月2日返院复查,查体:颈部活动明显受限,前屈约2 0°,后伸约15°,左右侧屈均为15°,左旋转4 0°,右…     

多层螺旋CT三维重建诊断尺骨冠状突骨折15例分析

2005年10月～2006年7月,我们共收治尺骨冠状突骨折15例,分别行X线摄片、CT扫描和三维重建(MPR、SSD),并进行对比分析。现报告如下。1临床资料1.1一般情况15例中,男9例,女6例;年龄15～65岁,平均35岁。致伤原因:跌倒8例,外力打击5例,交通事故2例。均为单侧损伤,其中左侧5例,右侧10例。1.2检查方法(1)本组病例均先行X线正、侧位检查,其中明确尺骨冠状突骨折4例,可疑骨折6例,正、侧位片未发现尺骨冠状突骨折征象5例。(2)采用德国SIEMENS Emition Duo型螺旋CT机,扫描层厚1mm,螺距1.5mm,重建间隔0.5mm。取俯卧位,患肢前伸,掌面朝上,头先…     

正常颈部钩椎关节X线分析

颈钩椎关节邻近重要的血管和神经,钩突的病变可出现一系列有关的血管和神经症状,钩突的改变在Ｘ线平片可清晰显示,因此对钩突关节Ｘ线表现有必要进行研究。资料与方法本组４０例患者中男２６例,女１４例,年龄为１８～７０岁。４０例正常成人颈椎,皆无任何颈部症状,无颈部外伤史。各拍颈椎正侧及斜位照片。机器：使用日本岛津１０００ＭＡ,ＲＳＺ—２００型Ｘ光机。距离：用点片摄影,１１０ｃｍ距离投照。摄片用正位,侧位及斜位,立位摄影。测量方法;（１）位置的选择：正、侧及斜位照片对比观察,正位像由于斜射线的关系,中心（…     

颅底凹陷症并寰椎后弓完全缺如及寰枢关节半脱位1例

病例女,36岁,汉族,无外伤史.因"颈部疼痛伴头晕、头痛9个月,加重2个月",于2010年12月15日入院.入院查体:颈椎生理曲度变直,颈部活动受限,前屈20°,后伸15°,左旋30°,右旋25°,左侧屈3°,右侧屈2°,C2 - 4双侧棘旁压痛,C2棘突明显压痛,无明显放射痛.椎动脉扭转试验阳性.四肢感觉肌力均正常,肌张力正常,生理反射正常,病理征均阴性.颈椎正侧位片示:枢椎齿状突前缘与寰椎前结节后缘间隙为6.7 mm.诊断:寰枢关节脱位.颈椎CT平扫及寰枢关节MSCT平扫+三维重建示:下颌内收,颈椎曲度变直,寰椎后弓完全缺如,寰枢关节间隙左侧宽,右侧窄,齿突与前弓内关节面间距约7 mm,齿突超过硬腭与枕骨大孔后缘连线(Chamberlain线)上约9.4 mm.诊断:颅底凹陷症;寰椎后弓完全缺如;寰枢关节半脱位.经颈部手法、经络导频、中药外敷等治疗半月后,颈部疼痛及头晕、头痛症状消失.查体:颈部活动达正常范围,颈部压痛点消失,椎动脉扭转试验阴性.随访1年后,患者无明显不适反应.     

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.     

颈椎病的CT诊断

作者分析了２６０例颈椎病的ＣＴ表现，特征性的ＣＴ表现对提供正确的诊断有帮助，其主要征像为：１．椎间盘突出及部分钙化；２．钩突增生肥大；３．椎体后缘及前周缘骨质增生；４．椎管、侧隐窝及椎间孔受压变窄；５．黄韧带肥厚；６．椎间盘“真空征”。本文对颈椎病ＣＴ检查的优点和限度作了简短的讨论。     

益脑推拿法对椎动脉型颈椎病患者颈椎生理曲度的影响

目的:观察益脑推拿法对椎动脉型颈椎病患者颈椎生理曲度的影响。方法:160例患者随机分为益脑推拿组(80例)和常规推拿组(80例),采用Borden氏法测量颈椎生理曲度,疗程结束后对两组患者颈椎生理曲度值的变化进行对照分析。结果:治疗后益脑推拿组、常规推拿组的颈椎生理曲度值分别为4.30±1.23 mm、3.55±1.82 mm,两组差别有显著性意义(t′=3.0309,P<0.05)。结论:改善或重建颈椎生理曲度可能是益脑推拿法治疗椎动脉型颈椎病的作用机制之一。     

下颈椎屈曲分离型损伤的临床特点与手术选择

目的探讨下颈椎屈曲分离型损伤的临床特点与手术选择。方法回顾性分析2007年1月～2010年12月收治的有随访资料的25例下颈椎屈曲分离型损伤病例。其中新鲜损伤（﹤11d）15例,5例出现脊髓损伤,4例出现神经根损伤;陈旧性损伤（1个月～25年）10例均出现明显的颈痛及不同程度脊髓压迫或者神经根刺激症状。15例新鲜损伤患者中11例牵引复位后行前路手术,4例复位失败者行前后路切开复位手术;10例陈旧性损伤患者均采用前路脱位椎下方椎体次全切除术。结果 25例术后随访平均13个月（6～21个月）,15例新鲜损伤有9例合并脊髓及神经根损伤,其中7例完全恢复。10例陈旧性损伤中8例患者颈痛及脊髓压迫神经根牵拉症状完全消失。X线片及CT提示椎体间融合好,颈椎生理曲度恢复满意。结论新鲜下颈椎屈曲分离型损伤患者应积极通过牵引或者手术复位,根据术前复位情况决定手术方式。陈旧性患者可不作勉强复位,通过脱位椎下方椎体次全切除亦能达到神经组织减压的目的 。     

Preventing the progression of text neck in a young man: A case report

Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which were consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy. The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the symptomatic and functional improvement was reflected by the radiographic changes in the cervical curve correction and the normalized paraspinal muscle tension on surface electromyology. Frequent breaks along with correct posture while using smartphones will be the key entities to prevent the occurrence of text neck syndrome.     

Determining the probability of detecting cervical spine fractures with computed tomographic scans using the visible human database

Cross-table lateral radiography alone is frequently unreliable for clearing of the cervical spine in cases of acute trauma. Computerized tomography (CT) is a standard procedure for detecting occult cervical spine fractures when cervical spine radiographs are equivocal or inadequate. There is evidence, however, that a significant number of fractures may still be missed by CT scans if too large a distance is used between scanning cuts in the axial plane. The purpose of this study was to determine the probability of detecting hidden fractures of the cervical spine over a wide range of fracture sizes and CT axial cut intervals. Digitized anatomic data of the cervical spine from the Visible Human Project^TM of the National Library of Medicine were used as a model template for the study. From a series analysis, it was determined that use of the standard 5-mm cut intervals missed 25–75% of fractures, depending on the size of the lesion. The 4-mm cuts were able to detect all of the 3-mm lesions but still missed a significant number of the smaller fractures. The probability of finding occult fractures at the 3-mm axial interval was 100% for all except the smallest fracture sizes. This mathematical analysis suggests that computerized tomography is a less than optimal method for detecting occult fractures of the cervical spine unless the cut interval is 3 mm or less. The addition of sagittal plane reconstruction of these images would further enhance the ability to detect subtle subluxations or fractures.     

The effect of protective equipment on cervical spine alignment in collegiate lacrosse players

BACKGROUND: Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known. HYPOTHESIS: Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment. STUDY DESIGN: Controlled laboratory study. METHODS: Sagittal plane cervical spine alignment was evaluated in 16 uninjured male collegiate lacrosse players using computed tomography. Patients were immobilized in the supine position on a standard spine board. Testing was performed without equipment, with both helmet and shoulder pads in place, and with the helmet removed. Angular measurements of the cervical spine were made and analyzed. RESULTS: The presence of both the helmet and shoulder pads caused an increase in overall cervical extension (mean, 6 degrees ) compared with the absence of both pieces of equipment (P = .002). Helmet removal alone resulted in a mean increase in cervical flexion of 4.7 degrees in the upper cervical spine compared with the presence of both pieces of equipment (P = .011). Compared with the absence of equipment, shoulder pads caused increased cervical flexion in the lower cervical spine (mean, 4.4 degrees ; P = .036). CONCLUSION: Protective equipment worn by lacrosse athletes causes statistically significant increases in cervical extension, and its removal causes statistically significant increases in cervical flexion. This alteration is different from that previously reported for protective equipment in football and ice hockey. CLINICAL RELEVANCE: The authors' recommendation is that both lacrosse helmets and shoulder pads be left in place until they can be completely removed in a controlled fashion. The effect of external equipment on neck position is different for lacrosse compared with football and ice hockey.     

Chronic repetitive unrecognized flexion injury of the cervical spine (high jumper's neck)

Unrecognized flexion injuries of the cervical spine may lead to late instability and neurologic damage. These hidden flexion injuries may be from acute or chronic traumatic episodes. Cervical spine instability was seen in an amateur high jumper as a result of chronic repetitive flexion loading of her cervical spine due to incorrect landing technique. The instability from these types of flexion injuries is generally unrecognized on a routine lateral radiograph. The presence of slight anterior subluxation, simple compression fractures, or subtle kyphotic angulation at one cervical level should alert the physician to this diagnosis. Flexion extension views are useful to demonstrate this instability. Occupations and sports which involve repetitive flexion stress to the cervical spine are at risk for this type of late instability. Therefore, in high jumping careful attention to safe techniques of landing is of utmost importance.     

上颈椎骨折的非手术治疗：5年经验总结

目的探讨采用非手术治疗上颈椎骨折的适应证并观察其疗效。方法检索我科近5年收治的44例上颈椎创伤患者病例资料,其中29例接受了非手术治疗,包括寰椎骨折6例,Hangman骨折7例（Ⅰ型4例,Ⅱ型3例）,齿状突骨折14例（Ⅱ型4例,Ⅲ型10例）,枢椎侧块骨折1例,枢椎体粉碎性骨折1例。采用的非手术治疗方法如下：Halo-vest支架固定14例,颈托固定4例,头颈胸支具固定11例。结果27例患者获得完整随访资料,2例失访,随访时间4～45个月。末次随访均可见骨折处愈合,未见寰枢关节不稳表现。结论采取适宜的非手术方法治疗上颈椎稳定性骨折,可取得较好的临床疗效。手术仅在寰枢关节稳定性遭到破坏且无法通过非手术治疗恢复时才必须实施。