轻中型颅脑损伤合并颈椎骨折的临床诊治

Diagnosis and Treatment of Fractures of Cervical Vertebrae Accompanied with Mild and Moderate Craniocerebral Trauma

目的总结轻中型颅脑损伤合并颈椎骨折的临床诊治经验,提高对颅颈联合伤的认识和重视程度。方法对我科近两年收治的42例轻中型颅脑损伤合并颈椎骨折患者的临床资料进行回顾性分析。结果行颅脑CT检查显示,29例可见不同程度的脑挫裂伤、硬膜外血肿、硬膜下血肿、脑内血肿或混合型血肿;颈椎CT和X线平片显示,单侧关节突骨折脱位14例,棘突骨折8例,单纯椎体楔形压缩性骨折8例,爆裂性骨折3例,齿突骨折7例,枢椎椎弓骨折2例;经CT血管造影或磁共振血管造影证实颈椎骨折合并椎动脉损伤7例。所有患者均未行开颅手术,针对颈椎骨折,采用颈托或颈围固定、枕颌带牵引等非手术治疗20例,另22例接受Crutchfield钳颅骨牵引、颈前路齿突骨折螺丝钉固定术或钢板内固定术治疗。出院时GOS分级5级24例,4级18例。结论颅颈联合伤在临床上并不少见,应高度重视对颅脑损伤患者的颈部检查和保护,早期应进行颈椎CT扫描并预防椎动脉等血管损伤并发症。

Objective To improve the recognition and thinking highly of the combined craniocervical trauma. Method The clinical data of 42 patients with craniocerebral trauma accompanied with fractures of cervical vertebrae were analyzed retrospectively. Results The craniocervival trauma was caused by traffic accident in 27 of 42 patients. The craniocerebral injury showed by CT scan included cerebral contusions and lacerations, epidural or subdural hematomas, intracerebral hematomas and mixing hematomas. There were not craniotomy indications in all the patients. The dislocations or fractures of the unilateral articular processes were observed in 14 cases, the fractures of the spinous processes in 8 cases, the wedge compression fractures of the vertebral bodies in 8 cases, blowout fractures of vertebral bodies in 3 cases, dens fractures in 7 cases, and vertebral arch fractures of the axes in 2 cases. The vertebral artery injury was confirmed by CTA or MRA in 7 patients with fractures of cervical vertebrae. Of 42 patients, 24 belonged in GOS grade 5 and 18 in GOS grade 4 when being discharged from hospital. Conclusions The combined craniocervical trauma is not rare clinically. It is important to perform cervical examination and protection, and the complication of traumatic vertebral arteries should be early prevented in the patients with craniocerebral trauma.