CAJ | 학술논문

目的：探讨颈椎骨折脱位并发前脊髓综合征(ASCS)的发病机制、病理特点及诊疗策略。方法总结2012年1月~2014年9月本院收治的32例颈椎骨折脱位并发ASCS患者的资料，对受伤机制、病理特点进行综合分析。所有患者均采用手术治疗。根据不同损伤特点采用单纯前路手术或前后路联合手术。结果所有患者均成功实施手术。发病机制：过屈型损伤22例(68.75%)，垂直打击5例(15.62%)，过伸型损伤1例(3.12%)，混合因素致伤4例(12.5%)。病理特点：单纯前脱位4例(12.5%)，骨折并发前脱位28例(87.5%)。诊断：入院初步诊断时仅8例成功诊断为ASCS，其余24例皆笼统为脊髓损伤。结论 ASCS并非少见，颈椎屈曲型损伤为其主要受伤机制。前脱位和骨折并发前脱位较常见，严格查体辅助CT、MRI有助于明确诊断。根据损伤机制，前路或前后联合入路手术是适当的治疗方法。
목적：탐토경추골절탈위병발전척수종합정(ASCS)적발병궤제、병리특점급진료책략。방법총결2012년1월~2014년9월본원수치적32례경추골절탈위병발ASCS환자적자료，대수상궤제、병리특점진행종합분석。소유환자균채용수술치료。근거불동손상특점채용단순전로수술혹전후로연합수술。결과소유환자균성공실시수술。발병궤제：과굴형손상22례(68.75%)，수직타격5례(15.62%)，과신형손상1례(3.12%)，혼합인소치상4례(12.5%)。병리특점：단순전탈위4례(12.5%)，골절병발전탈위28례(87.5%)。진단：입원초보진단시부8례성공진단위ASCS，기여24례개롱통위척수손상。결론 ASCS병비소견，경추굴곡형손상위기주요수상궤제。전탈위화골절병발전탈위교상견，엄격사체보조CT、MRI유조우명학진단。근거손상궤제，전로혹전후연합입로수술시괄당적치료방법。
Objective To study the mechanism, pathology, diagnosis and manage strategy of cervical fracture dislocation combined with anterior spinal cord syndrome (ASCS). Methods 32 cases of cervical fracture dislocation combined with ASCS from January 2012 to Sep-tember 2014 were summarized. The mechanisms of injury and pathological characteristics were analyzed. All of them received surgical treat-ment. Anterior approach or anterior approach combined with posterior approach was chosen according to the characteristics of injury. Re-sults All surgical treatments were successfully performed. There were 22 cases (68.75%) with hyperflexion, 5 cases (15.62%) with vertical hit, 1 case (3.12%) with hyperextension and 4 cases (12.5%) with multiple reasons. There were 4 cases (12.5%) with simple anterior disloca-tion, 28 cases (87.5%) with fracture combined with anterior dislocation. Only 8 cases were successfully diagnosed as ASCS, and the others (24 cases) were generally defined as spinal cord injury. Conclusion ASCS is not so rare. Hyperflexion injury is the most common mecha-nism. Anterior dislocation and fracture combined with anterior dislocation are the general types of pathology. Conscientious physical exami-nation with CT and MRI can facilitate the diagnosis. Anterior approach or combined with posterior approach could be selected according to injury mechanism.