并发于颅脑损伤的颈项损伤症候群的诊治

Diagnosis and managements in neck injury syndrome associate with craniocerebral injury

目的 分析并发于颅脑损伤的颈项损伤症候群的临床特点，探讨其诊断与治疗，以进一步提高颅脑损伤患者的治疗效果。方法 回顾性分析2000年6月～2003年7月处理的颅脑损伤患者283例，对其中并发颈项损伤症候群的患者进行分析。结果283例患者中有明确颈项征候群（症状或体征）者42例，占14．8％。其中明确诊断为颈部损伤者39例，占13．7％，临床推断为颈部损伤者3例。占1．1％。该症候群主要是指：与颅脑损伤的恢复不对应的顽固性、非中枢性、非耳源性眩晕，非中枢性、非耳源性、非消化道呕吐；与颅脑损伤的恢复不对应的，顽固性颈项强直、活动受限、被迫体位。顽固性颈项部疼痛或不适；一过性颈髓损害表现，以及通过简单的颈部制动、牵引、封闭、推拿、理疗与外用药就可以改善症状。结论 颅脑损伤并发颈项损伤症候群是常见病，认识并规范处理可以提高颅脑损伤治疗的综合疗效。

Objective To analyze the clinical behavior and correlative mechanism of the patients with the syndrome of neck injury associate with craniocerebral injury, to investigate its incidence for contributing to the diagnosis and therapy of the patients with the craniocerebral injury and improving the postoperative result. Methods Two hundred and eighty - three patients with craniocerebral injury treated from June 2000 to July 2003 were studied retrospectively. Results In 283 patients, 42 （14.8%） patients presented the syndrome of neck injury clearly in symptom or sign, of whom 39 （13.7 % ） patients were diagnosed neck injury finally, 3 （1.1% ） patients were clinically conclude neck injury. The syndrome mainly presents with noncerebral and nonaural vertigo incorresponding with the recovery of brain injury. Noncerebral, nonaural and nondigestive vomit. Intractable nuchal rigidity incorresponding with the recovery of brain injury. Motion and position limited, stubborn neck malaise, transient spinal cord injury. The symptoms were easy to be improved by neck motion control, neck traction, block therapy, massage and physiotherapy lamp. Conclusion The syndrome of brain - neck injury is a common injury. To learn the syndrome and take the regular therapy can improve the therapeutic efficacy of the craniocerebral injury.