小儿下颈椎损伤

小儿下颈椎损伤非常少见。本文报告８例，其中４例行手术治疗。结果４例恢复正常，３例无变化，１例死亡。作者还就小儿下颈椎的解剖特点、损伤机理、临床表现、诊断及治疗进行了讨论。     

下颈椎单关节脱位损伤的临床观察及诊治

目的探讨下颈椎单关节脱位损伤的诊断及治疗方法。方法对2002年8月~2007年8月间收治12例下颈椎(C3~7)单关节脱位损伤患者的临床表现及诊治方法进行回顾性分析。4例行牵引非手术治疗,3例牵引复位后行前路手术,2例行前后路手术,3例牵引复位无效,采取后路侧块钛板固定。结果12例均恢复了颈椎的正常序列和稳定性及运动功能。脊髓损伤和神经根刺激症状有不同程度的恢复和好转。结论下颈单关节脱位损伤较少见,可依靠其特有的症状、体征及X线片、CT进行诊断。应采取早期牵引复位,复位后行前路或后路内固定手术治疗;牵引复位失败者,可行后路切开复位固定,不会加重脊髓损伤。     

颅脑损伤合并颈椎颈髓损伤的早期诊治

临床工作中颅脑损伤合并颈椎颈髓损伤并非少见,但由于颅脑损伤的症状和体征会掩盖颈椎颈髓损伤的症状和体征,早期诊断不易,给预后带来一定影响。1995．10～2000．10,我院收治了19例该类病人,现就早期诊治作一探讨．     

颅脑外伤合并颈椎损伤的诊治分析

颅脑外伤往往由于头部受到直接或间接暴力而致伤,在受伤同时颈部由于机体的保护性机制,而产生顺应力,常可能合并颈部损伤,受伤后常合并有寰枢关节脱位或半脱位．严重的可引起颈髓损伤．甚至可能因呼吸中枢受损进而危及生命,或严重影响患者预后。本院自2004年1月至2008年12月间共收治颅脑外伤合并颈椎损伤病人167例,现就将其诊治结果及经验教训分析报告如下。     

下颈椎关节脱位的诊治进展

下颈段是人体脊柱的重要活动部位,由创伤引起的下颈椎小关节脱位在临床较常见。由于受伤机制不同,可导致不同类型的脱位,其病理改变和临床表现也不一致。建立快速而准确的诊断以及早期而有效的治疗,是处理此类型疾病、获得良好效果的关键。如何协调好检查、诊断以及选择恰当治疗方案之间的关系,把握正确的治疗时机和方法非常重要,现对此作出综述如下。     

下颈椎小关节脱位的诊治

下颈椎小关节脱位以牵拉屈曲型为常见,MRI可观察脊髓和椎间盘损伤并判断颈椎稳定性.治疗策略有明显转变,表现在肯定传统牵引优越性的同时需谨慎重新看待其安全性和必要性,对Ⅳ°脱位或完全分离者不宜牵引,需尽早手术.若患者神经功能完整,应在颈椎严格制动下作MRI评价,无椎间盘损伤或突出者可试牵引复位,否则直接行前路摘除椎间盘减压复位固定,前路不能复位再考虑后路复位;若患者有神经损伤,为避免延误复位,可先试行牵引复位再作MRI,椎间盘完整者作后路复位固定,否则作前路复位固定.陈旧性小关节脱位的治疗争论较多,多采用一期前后路联合360°或540°术式;前后路联合时,后路宜采用弹性非坚强固定,以利于前路进一步复位.     

上颈椎损伤合并不连续下颈椎损伤的一期手术治疗

目的 探讨上颈椎损伤合并不连续的下颈椎损伤的临床特点及手术治疗策略.方法 2004年5月至2007年8月,对上颈椎损伤合并不连续的下颈椎损伤9例患者进行一期手术治疗.术前神经功能按Frankel评级:A级2例,C级3例,E级4例.其中上颈椎损伤均采用后路手术,经椎弓根寰枢固定融合8例,枕颈固定1例;下颈椎损伤采用后路手术6例,其中以不连续经椎弓根短节段钉棒固定融合4例,2例采用联合上颈椎经椎弓根连续固定;余3例同期行前路减压钛板固定.结果 所有患者获得6～48个月(平均13.7个月)随访.术中无一例椎动脉损伤.术后无气管切开或拔管延迟情况,无严重肺部感染、呼吸衰竭、应激性溃疡等并发症发生.患者复位及融合满意,1例2枚下颈椎椎弓根断钉.神经功能:除2例Frankel A级的患并无恢复外,余均为E级.结论 上颈椎损伤合并不连续下颈椎损伤导致颈椎极度不稳定,伴有的神经损伤常源于下颈段.一期手术治疗,包括上颈椎后路经椎弓根固定及下颈椎后路经椎弓根或前路减压固定,相对安全且可获得满意疗效.     

下颈椎小关节脱位合并椎间盘损伤

下颈椎小关节脱位是一种严重的创伤，约占颈椎创伤的5％～7％，它常常合并椎间盘损伤。因此，了解下颈椎小关节及颈椎间盘的解剖、小关节脱位合并椎间盘损伤的创伤机制、发生率，掌握正确的诊断、治疗方法十分必要。     

下颈椎小关节脱位合并椎间盘损伤

下颈椎小关节脱位是一种严重的创伤,约占颈椎创伤的5％~7％,它常常合并椎间盘损伤。因此,了解下颈椎小关节及颈椎间盘的解剖、小关节脱位合并椎间盘损伤的创伤机制、发生率,掌握正确的诊断、治疗方法十分必要。     

下颈椎损伤的诊断与治疗

下颈椎损伤是指直接或间接暴力所致的第3至第7颈椎（C3-7）骨、关节及韧带的损伤，也包含颈胸交界部即第7颈椎至第1胸椎（C7-T1）的损伤。颈椎损伤常伴有脊髓损伤。及时正确的诊断和治疗可防止和逆转脊髓的继发性损伤，使脊髓功能获得最大程度的恢复，降低伤残率或伤残程度，从而提高患者的生存率及生活质量。     

Basic principles of management for cervical spine trauma

This article reviews the basic principles of management of cervical trauma. The technique and critical importance of careful assessment is described. Instability is defined, and the incidence of a second injury is highlighted. The concept of spinal clearance is discussed. Early reduction and stabilisation techniques are described, and the indications, and approach for surgery reviewed. The importance of the role of post-injury rehabilitation is identified.

     

Airway management in adults after cervical spine trauma

Cervical spinal injury occurs in 2% of victims of blunt trauma; the incidence is increased if the Glasgow Coma Scale score is less than 8 or if there is a focal neurologic deficit. Immobilization of the spine after trauma is advocated as a standard of care. A three-view x-ray series supplemented with computed tomography imaging is an effective imaging strategy to rule out cervical spinal injury. Secondary neurologic injury occurs in 2-10% of patients after cervical spinal injury; it seems to be an inevitable consequence of the primary injury in a subpopulation of patients. All airway interventions cause spinal movement; immobilization may have a modest effect in limiting spinal movement during airway maneuvers. Many anesthesiologists state a preference for the fiberoptic bronchoscope to facilitate airway management, although there is considerable, favorable experience with the direct laryngoscope in cervical spinal injury patients. There are no outcome data that would support a recommendation for a particular practice option for airway management; a number of options seem appropriate and acceptable.     

Subaxial cervical spine trauma

Subaxial cervical spine injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture-dislocation with bone and ligament failure, resulting in severe spinal cord injury. Understanding the epidemiology, anatomy, biomechanics, and classification of subaxial cervical spine injuries is important. Emergent management of such injuries is based on obtaining an accurate clinical history, careful physical examination, and organized radiographic evaluation. Attaining a unified approach to the wide spectrum of subaxial cervical injuries is difficult. In addition, controversy exists regarding the safety of closed reduction in certain injury patterns and the administration of methylprednisolone for acute spinal cord injury. Definitive management (surgical or nonsurgical) is based on the assessment of the mechanical instability of the injury, the presence or absence of neurologic impairment, and various patient factors that may influence outcome. Several complications, including the deterioration of neurologic status, may occur with either surgical or nonsurgical management, but the most frequent mistake made is missing the injury on initial evaluation.     

Pediatric cervical spine trauma

Pediatric cervical spine injuries are rare and are associated with significant morbidity and mortality. Pediatric anatomy and physiology predispose to upper cervical spine injury and spinal cord injury without radiologic abnormality in contrast to lower cervical spine injury seen in adults. Care of pediatric patients is difficult because they have a greater head-to-body ratio than adults and may have difficulty cooperating with a history and physical examination. In evaluating a child with a suspected cervical spine injury, radiography may be supplemented with CT or MRI. Definitive management of pediatric cervical spine trauma must be adapted to the distinctive anatomy and growth potential of the patient. As with all injuries, prevention is necessary to reduce the incidence of trauma to the pediatric spine.     

Circumferential fusion for the management of acute cervical spine trauma.

Combined, single-stage anterior and posterior approaches for acute surgical management of cervical spine injury allows for early restoration of anatomic alignment and decompression. Six patients underwent single-stage anterior decompression and posterior instrumentation and fusion at Vanderbilt University Medical Center between 1984-1989. There was no late deformity. Five patients had incomplete neurologic deficits, and each improved a minimum of one Frankel classification. One patient had complete neurologic deficit at the C5 level. The procedure is lengthy, with an average time under anesthesia of 7.7 hs. Since this procedure allows for immediate mobilization, it should be considered for the management of cervical spine fractures with both anterior and posterior column instability.