颅脑损伤合并颈椎损伤的诊治

Diagnose and treatment of craniocerebral injury complicated with cervical spine injury

目的总结对颅脑损伤合并颈椎损伤病人的诊治经验。方法回顾性分析46例颅脑损伤合并颈椎损伤病人的临床资料。结果术后生存42例,死亡4例。颈椎损伤病人早期漏诊5例,因未及时行颈椎X-线平片或CT检查,致死亡1例,截瘫1例。颅骨牵引继发硬膜外血肿或原血肿加大者4例,新增血肿多在颅骨骨折处,而颅骨骨折多因入院未行CT骨窗扫描漏诊或被忽略,致死亡1例。吸取上述经验后,对5例颅颈复合伤病人一经确诊即与骨科同台早期手术。结论对颅颈复合伤病人,早期行颈椎CT、X-线平片检查及头颅CT骨窗扫描可减少颈椎损伤及颅骨骨折漏诊率。早期脑外科与骨科同台手术,可减少并发症。

Objective To summarize the experiences in diagnoses and treatment of cranioeerebral injury complicated with cervical spine injury. Methods The clinical data of 46 cases with craniocerebral injury complicated with cervical spine injury were analyzed retrospectively. Results Forty-two cases survived and 4 cases died after the operation. Five patients with cervical spine injury suffered missed diagnosis in the early period, mostly of whom were due to be overlooked of the cervical spine injury and absence of cervical spine CT or radiography in time. In the result, 1 died and 1 suffered paraplegia. Four patients suffered epidural hematoma or enlargement of original hematoma secondary to skull traction, and the new hematomas were found at the fracture site, which was missed diagnostically because of omitted bone window CT scanning on admission, leading to 1 death. The 5 patients with craniocerebral complex injuries received craniotomy and orthopedic surgery simultaneously, with a decrease of complications. Conclusion The cervical CT scan, radiography and bone window CT scanning should be obtained at the early period after cranioeerebral injury complicated with cervical spine injury for reducing the rate of missed diagnosis. The early simultaneous craniotomy and orthopedic surgery will help reduce complications.