无骨折脱位型颈脊髓损伤诊断和治疗

目的：探讨无骨折脱位型颈髓损伤的诊断及治疗方法。方法：回顾性分析56例确诊无骨折脱位型脊髓损伤病例的临床资料。男24例，女32例；年龄21～73岁，平均54岁。脊髓损伤平面与类型：C2 2例，C3 1例，C4 5例，C5 18例，C6 15例，C7 11例，C8 4例。完全性脊髓损伤11例，不完全性脊髓损伤45例。在不完全性脊髓损伤中，表现为脊髓中央综合征的29例，脊髓前侧综合征为10例，BrownSepuard综合征3例，脊髓后部损伤的为3例。结果：56例无颈椎骨折或脱位的颈髓损伤患者中，48例伤后1周之内接受颈椎CT扫描检查，颈髓病变的检出率为79．17％。52例在伤后1周之内、4周后接受MRI检查，脊髓病变阳性检出率为90．38％。A组：26例在伤后1周之内接受手术治疗，完全改善2例，明显改善15例，部分改善6例，无改善3例。B组：3例在2周内接受手术治疗，明显改善1例，部分改善1例，无改善1例。C组：5例在2个月内接受手术治疗，脊髓功能均无改善。D组：17例进行非手术治疗，完全改善1例，明显改善9例，部分改善2例，无改善5例。有5例患者在治疗过程中因并发症死亡。结论：MRI对了解脊髓病变部位与程度，原发病病变的情况，预测病理变化的转归，都明显优于CT检查。治疗方面非手术治疗不可缺少，但适时选择手术治疗会取得更好的治疗结果。

Diagnosis and early treatment of cervical spinal cord injury without fracture and dislocation

Objective:To explore diagnosis and treatment of cervical spinal cord injury without fracture and dislocation.Methods:Clinical data of 56 patients (male,24 cases;female,32 cases)of cervical spinal cord injury without fracture were analyzed retrospectively,the average age was 54 years (range from 21 to 73 years).There were 2 cases of C_2 spinal cord injury,1 case of C_3,5 cases of C_4,18 cases of C_5,15 cases of C_6,11 cases of C_7 and 4 cases of C_8.There were 11 cases of complete spinal cord injury and 45 cases of incomplete spinal cord injury,which including 29 cases of central cord syndrome,10 cases of anterior cord syndrome,3 cases of Brown-Sequard syndrome and 3 cases of posterior cord injury.Results:In the 56 patients,48 cases were finally diagnosed by CT within one week after injury and the positive rate was 79.17%.52 cases were finally diagnosed by MRI within one week and after 4 weeks,the positive rate was 90.38%.Group A:26 cases were operated within one week,2 cases had fully restoration,15 cases had markedly restoration,6 cases had partially restoration and 3 cases had no restoration.Group B:3 cases were operated within two weeks,the grade of restoration were 0,1,1,1 respectively.Group C:5 cases were operated within two months and no one obtained restoration.Group D:17 cases were traditionally treated,the grade of restoration were 1,9,2,5 respectively.Conclusion:MRI is excellent than CT scan in understanding the position and degree of spinal cord injury,the condition of primary injury and forecasting the outcome of pathological change.Traditional treatment is indispensable,but choosing right operative time can get a better effect.