推拿致急性颈脊髓损伤21例

Acute Cervical Spinal Cord Injury Caused by Manipulation

目的探讨颈肩痛行推拿或按摩治疗引起急性颈髓损伤的原因及防治措施。方法回顾性分析２１例按摩致急性脊髓损伤患者的临床特点及Ｘ线资料，测量每例Ｃ３～Ｃ７椎体矢状径和椎管矢状径并求其比值。２１例患者均于损伤后早期行后路椎管扩大成形术并植骨融合稳定脊椎。结果２１例患者按摩或推拿前有发育性椎管狭窄１５例，占７１．４％；有６例存在退变性狭窄，占２８．６％。所有患者经手术治疗均获满意效果。结论医务人员对此类病人作推拿之前，应常规摄颈椎过伸、过曲侧位片，并注意了解椎管管径大小和椎间关节稳定情况，以防止医源性损伤。如存在节段不稳，应视为推拿禁忌。脊髓损伤发生后，早期行椎管扩大成形术对病人起积极治疗作用。

Objective To study the etiology, prevention and treatment of acute cervical spinal cord injury induced by manipulation and massage. Methods Twenty-one cases of acute cervical spinal cord injury caused by manual treatment were reviewed. Sagittal diameters of the spinal canals and vertebral bodies (C3-C7) were measured in every patient, and the ratios were calculated. All patients underwent surgical operations. Results Of the 21 cases, 15 (71.4%) belonged to developmental stenosis of the spinal canals and 6 retrograde stenosis before manipulation. Conclusions Hyperextentionally and hyperflexionally lateral roentgenograms of the cervical vertebrae should be taken as a routine before manual treatment. More attention should be paid to the sagittal diameters of the spinal canal and stability of the intervertebral joints simultaneously. Regional instability of intervertebral joints should be regarded as contraindication for manipulation. Surgical decompression and enlargement of the spinal canal at early stage after spinal cord injury is helpful to the patients.