下颈椎骨折脱位合并脊髓损伤早期急救治疗对预后的影响

目的探讨下颈椎骨折脱位合并脊髓损伤的早期治疗方法和护理注意事项及其对预后的影响。方法回顾性分析183例伤后3 d内入院的颈椎骨折脱位合并脊髓损伤患者,其中男性120例,女性63例;年龄17~81岁,平均年龄36.5岁。入院时间均在受伤后3d内,平均26h(2~68h),所有患者均发生不同程度四肢瘫痪,按照Frankel分级:A级95例,B级28例,C级20例,D级40例。脊髓损伤水平:C23例,C311例,C429例,C584例,C637例,C719例。受伤类型:高处坠落伤21例,车祸伤162例。结果日本骨科学会(JOA)评分术前(4.2±1.8)分,术后1周(7.9±2.2)分,末次随访(10.0±2.0)分。术后1周、末次随访与术前比较差异均有显著统计学意义(P0.01)。8 h内行甲强龙冲击治疗65例,行早期气管切开38例,行前路手术110例,后路手术42例,前后路联合手术31例。死亡3例,低蛋白血症20例,肺感染6例,深静脉血栓2例。结论早期正确的治疗措施可有效提高颈椎骨折脱位合并脊髓损伤的疗效,降低其并发症的发生。

Influence on prognosis of early emergency treatment for lower cervical spine fracture and dislocation with spinal cord injury

Objective To investigate the early emergency treatment and nursing precautions of lower cervical fracture and dislocation with spinal cord injury, and its influence on prognosis. Methods A total of 183 cases of cervical fracture and dislocation combined with spinal cord injury were enrolled, which included 120 males and 63 females, aged 17- 81 years old with mean age of 36.5. All of cases were hospitalized within 3 days after injured with mean hours of 26（2- 68 hours）, all of which were varying degrees of quadriplegic. Frankel grades were grade A（95 cases）, grade B（28 cases）, grade C（20 cases） and grade D（40 cases）,respectively. Spinal cord injury levels were C2（3 cases）, C3（11 cases）, C4（29 cases）, C5（84 cases）, C6（37 cases） and C7（19 cases）,respectively. The types of injuries were 21 cases of falling and 162 cases of traffic accident. Results The Japanese Orthopaedic Association（JOA） scores were（4.2 ± 1.8） points preoperative,（7.9 ± 2.2） points 1-week after surgery, and（10.0 ± 2.0） points of last follow-up, which were statistically differences（P ＆lt; 0.01）. There were 65 cases of methylprednisolone impact treatment within 8hours, 38 of tracheotomy, 110 of anterior surgery, 42 of posterior surgery, and 31 of combined anterior, respectively. It was occurred that three patients died; 20 patients showed hypoproteinemia; 6 patients showed lung infection; 2 patients showed deep vein thrombosis. Conclusion It is demonstrated that the early and correct treatment could effectively cure cervical spine fracture and dislocation combining with spinal cord injury, and reduce the incidence of complications.