颈椎小关节突脱位闭合复位前后椎间盘和脊髓的损伤变化

目的　观察颈椎小关节突脱位闭合复位前后椎间盘和脊髓的损伤变化。方法　 16例颈椎小关节突脱位患者 ,7例单侧小关节突脱位 ,9例双侧小关节突脱位 ,在X线透视下行颅骨牵引闭合复位 ,并于复位前后进行神经功能和颈椎MRI检查 ,比较椎间盘脱出和脊髓实质损伤的变化。结果　 16例均闭合复位成功 ,复位前 5例有明显椎间盘脱出 ,4例有椎间盘撕裂 ,7例无明显椎间盘损伤。复位成功后 ,4例椎间盘脱出仍存在 ,大小无变化 ;1例原脱出椎间盘明显缩小 ,无新椎间盘脱出发生。14例复位前后脊髓信号无变化 ,2例复位后出现MRIT2 加权高信号增强。 16例复位后无一例出现神经功能恶化。结论　颅骨牵引闭合复位不会诱发或加重椎间盘脱出 ,进而造成继发性脊髓功能损伤

The Change of the Disc and Spinal Cord Injury Before and After Closed Traction Reduction of Cervical Spine Dislocation

Objective To observe the disc and spinal cord injury before and after closed traction reduction of cervical spine dislocation.Methods There were 16 cases of cervical spine dislocation,7 unilateral and 9 bilateral.All patients were undergone neurological function and cervical spine MRI examination before and after closed traction reduction.The disc herniation and spinal cord injury were compared.Results Closed traction reduction was successful in all patients.Five patients had disc herniation,4 patients had disc disruption and 7 patients had no disc injury before reduction.After successful closed traction reduction,4 patients had similar disc herniation,one patient had only significant smaller disc herniation comparing with before reduction.There was no new disc herniation after reduction.Fourteen patients had no change of spinal cord sign on MRI image before and after reduction.Two patients had increase high density sign on MRI T 2 image.But there were no neurological worsening after reduction.Conclusion Closed traction reduction could not increase the disc herniation and cause further spinal cord injury.