颅脑损伤并颈椎颈髓损伤治疗体会

Treatment of head injury combined with cervical spine and spinal cord injury

目的探讨颅脑损伤合并颈椎骨折颈段脊髓损伤（颅颈联合伤）的诊疗经验。方法回顾性分析58例颅脑损伤并颈椎颈髓损伤病人,首诊常规颈椎制动和普查影像学资料,筛选此类病例进一步分析研究。结果作者医院创伤外科2007~2008年共收治颅脑损伤患者1107例,通过筛选颅颈联合伤患者共58例。颈椎损伤治疗中,11例予以颈前路椎板减压＋椎间盘摘除＋自体骨移植复位内固定术,余47例予以颅骨牵引或外固定器械治疗。颅脑损伤治疗中,21例急诊行颅脑手术治疗,非手术治疗37例。本组患者存活55例,死亡3例,生存率94.8%。按格拉斯哥预后评分（GOS）评定为Ⅰ级3例,Ⅱ级2例,Ⅲ级3例,Ⅳ级7例,Ⅴ级43例。结论颅颈联合伤发病率较高,本组约占5.2%。颅颈联合伤的主动普查（影像学）和颈部保护制动,防止脊髓二次损伤,对降低漏诊、提高临床治愈率有重要意义。

Objective To summarize the experiences in diagnosis and treatment of cervical spine and cervical cord injury combined with head injury.Methods The clinical data of 58 cases with cervical spine and cervical cord injury combined with head injury were retrospectively analyzed.All the patients were given the external fixation and radiology examination.Results There were 1107 head injury patients who were treated in the trauma surgery department of author＇s hospital during 2007-2008.There were 58 patients with cervical spine and cervical cord injury combined with head injury.For cervical spine injury,11 cases were given cervical operation,the remaining 47 cases were treated by skull traction and fixator.For head injury,21 cases were performed craniocerebral operations emergently,and the remaining 37 cases were performed conservative treatment.Results showed that 55 cases survived and 3 cases died.As for Glasgow Outcome Scale（GOS） score,3 cases were ranked at grade Ⅰ,2 at grade Ⅱ,3 at grade Ⅲ,7 at grade Ⅳ and 43 at grade Ⅴ.Conclusion The morbidity of cervical spine and cervical cord injury with head injury is 5.2% in our research group.The routine external fixation and radiology examination in these patients contribute to improving prognosis and decreasing the missed diagnosis and the secondary injury in cervical spine.