颈椎脱位治疗策略

目的：探讨颈椎脱位治疗方法选择。方法：颈椎脱位患者39例,男29例,女10例;年龄6～74岁,平均为40岁。脱位节段：C1,215例,C3,41例,C4,59例,C5,69例,C6,75例。脊髓损伤按Frankel分级：A级9例,B级8例,C级5例,D级8例,E级8例,仅有神经根症状1例。32例进行了早期、快速、重量递增的牵引治疗。17例进行手术治疗。结果：牵引复位成功率90%,脊髓损伤平均改善0.63级。死亡6例,均为关节突交锁并严重脊髓损伤病例。结论：快速复位牵引治疗颈椎脱位,需密切观察病情,严防牵引过度。是否手术应根据复位情况、MRI表现、脊髓损伤及全身状况与条件综合考虑。

Strategy of the treatment for dislocation of cervical vertebra

Objective: To study the strategy of the treatment for dislocation of cervical vertebra. Methods: The clinical data of 39 cases with dislocation of cervical vertebra were analyzed. Among them,29 were male and 10 were female. The average age was 40 years old(range from 6 to 74 years old). Segment of dislocation:15 cases in C_1,2,1 case in C_3,4,9 cases in C_4,5,9 cases in C_5,6,5 cases in C_6,7. Spinal injury according to Frankel grade,9 cases were A grade,8 were B,5 were C,8 were D,8 were E,1 case had radicular symptom. Thirty-two cases were early and rapidly treated with traction(progressive weight). Seventeen cases were treated with operation. Results: Traction-reduction was successful in 90% of patients. According to Frankel grade,32 cases averagely improved 0.63 grades. Six cases of severe spinal injury accompany with interlocking of zygopophysis died. Conclusion: Inspecting weight of traction is important in rapid traction-reduction for dislocation of cervical vertebra. The choice of surgical treatment depends on the degree of reduction,the result of MRI,the grade of spinal trauma and the status of patients.