上下位颈椎多发伤的治疗

Combined injuries to the upper and lower cervical vertebrae

目的 探讨上下位颈椎多发伤的治疗策略.方法 2000年3月至2008年3月共收治9例上下位颈椎多发伤患者,男5例,女4例;年龄18～67岁,平均39.3岁;受伤至就诊时间为2 h～7d,平均3.2 d.有颈脊髓或神经根损伤症状者5例,只表现为颈部局部疼痛、运动功能受限者3例.采用牵引及Dick夹板或头颈胸石膏固定治疗2例;于术治疗7例：单独上颈椎固定1例,单独下颈椎固定3例,上下位颈椎联合固定3例,术后给予Dick夹板或颈托固定.结果 除1例术后6个月死于肺部感染外,其余8例患者获6～32个月（平均19个月）随访.无牵引及手术并发症,5例神经症状减轻或消失,所有患者骨折愈合或植骨融合良好,无假关节形成及颈椎不稳.结论 上下位颈椎多发伤需要根据稳定性和神经损伤程度确定保守治疗或手术治疗,手术治疗时应先稳定下位颈椎.

Objective To investigate the treatment of combined injuries tu the upper and lower cervical vertebrae. Methods Nine consecutive patients （4 females and 5 males） with combined injuries to the upper and lower cervical vertebrae underwent different treatments in our department from March 2000 to March 2008. Their mean age was 39.3 years, ranging from 18 to 67 years. Six cases had neurological deficits. Two cases received conservative management （4 weeks of cervical traction followed by Dick splint or plaster fixation）. Seven cases received different kinds of operation （upper cervical fixation in one case, lower cervical fixation in 3 cases and upper plus lower cervical fixation in the other 3 cases） followed by postoperative immobilization with Dick splint or neck support. Results One case died of respiratory infection 6 months after operation. The other 8 cases were followed up from 6 to 32 moths, with an average of 19 months.There were no neurological or vascular complications during surgery or traction. There were no cases of implant failure. Neurological symptoms were improved significantly in 5 cases. At the final follow-up, all patients demonstrated evidence of solid fusion on radiographs. Conclusions The stability of the upper and lower cervical spine and the severity of nerve injury determine whether conservative treatment or open surgery should be indicated for combined injuries to the upper and lower cervical vertebrae. In surgery, the lower cervical vertebra should be stabilized first of all.