CAJ | 학술논문

目的探讨无脊髓损伤的单节段下颈椎骨折脱位的临床治疗策略及疗效观察。方法选择近4年来17例曾诊断为无脊髓损伤的单节段下颈椎骨折脱位患者17例为观察对象，根据患者受伤机制、致伤力分级、辅助检查和临床症状选择治疗方式，其中非手术治疗4例，手术治疗13例，观察治疗前后及术后1年的临床效果。结果保守治疗的4例患者中，有共2例治疗效果良好，骨折愈合差的有1例、关节突脱位复位后颈椎稳定性差的有1例，但均未出现脊髓受损伤的情况。手术治疗的13例患者中，术后当日所有患者均有不同程度的症状改善，治疗效果良好的有7例，出现暂时性吞咽困难的有1例、暂时性声音嘶哑的有2例，供骨区疼痛的有3例。术后6个月随访的患者颈椎的稳定性重建效果均达到良好。所有病例患者无脊髓神经受损或加重，无食管瘘及颈部血肿等并发症发生。结论根据无脊髓损伤颈椎骨折脱位患者的致伤力能量、受伤机制、影像学表现及临床症状的不同，有针对性地选择合理的治疗方法，可以获得良好的临床疗效。对于无脊髓损伤的稳定性单节段下颈椎骨折脱位应行坚持牵引、制动、复位、固定的原则进行治疗；手术治疗中前路手术除了可以达到减压及恢复颈椎间高度和生理曲度外，更重要的是可重建颈椎即刻的稳定性，对防止继发性脊髓损伤有非常重要的作用。
목적탐토무척수손상적단절단하경추골절탈위적림상치료책략급료효관찰。방법선택근4년래17례증진단위무척수손상적단절단하경추골절탈위환자17례위관찰대상，근거환자수상궤제、치상력분급、보조검사화림상증상선택치료방식，기중비수술치료4례，수술치료13례，관찰치료전후급술후1년적림상효과。결과보수치료적4례환자중，유공2례치료효과량호，골절유합차적유1례、관절돌탈위복위후경추은정성차적유1례，단균미출현척수수손상적정황。수술치료적13례환자중，술후당일소유환자균유불동정도적증상개선，치료효과량호적유7례，출현잠시성탄인곤난적유1례、잠시성성음시아적유2례，공골구동통적유3례。술후6개월수방적환자경추적은정성중건효과균체도량호。소유병례환자무척수신경수손혹가중，무식관루급경부혈종등병발증발생。결론근거무척수손상경추골절탈위환자적치상력능량、수상궤제、영상학표현급림상증상적불동，유침대성지선택합리적치료방법，가이획득량호적림상료효。대우무척수손상적은정성단절단하경추골절탈위응행견지견인、제동、복위、고정적원칙진행치료；수술치료중전로수술제료가이체도감압급회복경추간고도화생리곡도외，경중요적시가중건경추즉각적은정성，대방지계발성척수손상유비상중요적작용。
Objective To explore without spinal cord injury of the cervical spine fracture dislocation clinical treatment strategies and curative effect observation. Methods choose our nearly four years have no diagnosis and treatment of spinal cord injury patients with cervical spine fracture dislocation of the 34 patients, according to patients with the mechanism of injury, the injury force classiifcation, assistant examination and clinical symptoms choice treatment, including 11 cases non-operative therapy, surgical treatment in 23 cases, observed before and after treatment and postoperative 1 year. Results The conservative treatment of 11 patients, there are a total of 5 cases of treatment effect is good, the fracture healing difference of 3 cases, joint process dislocation reset after cervical instability of 3 cases, but all did not appear the spinal cord injury. The surgical treatment of 23 patients, postoperative day all of these cases have different degrees of improvement of symptoms, treatment effect good have 15 cases, the transient of dysphagia in 2 cases, temporary cracked in 2 cases, for bone pain area 3 cases. After 6 months follow-up of patients with cervical stability reconstruction effect achieved good. All the cases without spinal nerve damage or aggravate, no esophageal ifstula and neck complications, such as the hematoma. Conclusion According to the injury of cervical fracture dislocation patients without injury force energy, mechanism of injury, imaging manifestations and clinical symptoms of different spinal cord, targeted therapies for selection of a reasonable, can achieve good clinical efifcacy. For the traction, braking, should be reset, a ifxed principle of treatment of fracture and dislocation without spinal cord injury of the stability of single segmental cervical anterior operation;operation treatment can achieve the relief and recovery of cervical intervertebral height and lordosis, more important is to reconstruct cervical instant stability, to prevent secondary spinal cord injury have a very important role.