颈椎脱位治疗策略

Strategy of the treatment for dislocation of cervical vertebra

目的:探讨颈椎脱位治疗方法选择。方法:颈椎脱位患者39例,男29例,女10例;年龄6～74岁,平均为40岁。脱位节段:C1,215例,C3,41例,C4,59例,C5,69例,C6,75例。脊髓损伤按Frankel分级:A级9例,B级8例,C级5例,D级8例,E级8例,仅有神经根症状1例。32例进行了早期、快速、重量递增的牵引治疗。17例进行手术治疗。结果:牵引复位成功率90%,脊髓损伤平均改善0.63级。死亡6例,均为关节突交锁并严重脊髓损伤病例。结论:快速复位牵引治疗颈椎脱位,需密切观察病情,严防牵引过度。是否手术应根据复位情况、MRI表现、脊髓损伤及全身状况与条件综合考虑。

Objective：To study the strategy of the treatment for dislocation of cervical vertebra. Methods：The clinical data of 39 cases with dislocation of cervical vertebra were analyzed. Among them, 29 were male and l0 were female. The average age was 40 years old （range from 6 to 74 years old）. Segment of dislocation ： 15 cases in CI.2, 1 case in C3,4,9 cases in C4.5,9 cases in C5.6,5 cases in C6,7. Spinal injury according to Frankel grade,9 cases were A grade, 8 were B,5 were C, 8 were D, 8 were E, 1 case had radicular symptom. Thirty-two cases were early and rapidly treated with traction （progressive weight）. Seventeen cases were treated with operation. Results ：Traction-reduction was successful in 90% of patients. According to Frankel grade, 32 cases averagely improved 0.63 grades. Six cases of severe spinal injury accompany with interlocking of zygopophysis died. Conclusion： Inspecting weight of traction is important in rapid traction-reduction for dislocation of cervical vertebra. The choice of surgical treatment depends on the degree of reduction,the result of MRI,the grade of spinal trauma and the status of patients.