颈椎骨折及合并截瘫的急诊治疗探讨

A study of treating fracture of cervical vertebral body complicated with paraplegia

目的 :探讨颈椎骨折合并截瘫的损伤机理和救治原则。方法 :对近 10年来 ,本院急诊收住入院的颈椎骨折及合并截瘫病人共 45例进行了回顾性研究。结果 :本组男性 38例 ,女性 7例 ,年龄 18～ 6 5岁 ,损伤原因为直接暴力及间接暴力而致。屈曲压缩骨折 32例 ,爆裂型骨折 3例 ,骨折脱位 6例 ,单纯脱位 4例 ;完全截瘫 30例 ,不全截瘫 9例 ,无截瘫 6例。非手术治疗 2 6例 ,其中截瘫恢复 4例 ,死亡 10例 ,8例症状无改变 ;手术治疗 19例 ,好转 16例 ,无效 3例。总的病死率为 2 2 2 % ,好转率为 35 5 % ,治愈率为 8 8% ,无效率 33 3%。结论 :颈椎骨折 ,不论其有无截瘫 ,为骨科最严重的创伤之一 ,应根据危及生命的轻重缓急来决定抢救的手段和形式 。

Objective:To study the mechanism of injury of fracture of cervical vertebral body complicated with paraplegia and the principle of treatment.Methods:A retrospective analysis was made of 45 cases of fracture of cervical body complicated with paraplegia,admitted to our hospital in the recent 10 years.Results:In this group there were 38 male patients and 7 female,aged from 18～65.The causes of injury included direct and indirect violence.There were compression fracture in flexion(17),turst fracture(3),fracture dislocation(6)and simple dislocation(4).Thirty out of 45 cases were patients with complete paraplegia,incomplete paraplegia(9)and without paraplegia(6).Twenty six cases were treated non-operatively,and among them 4 cases with paraplegia recovered and 10 cases died,or were dying,and hence were discharged against advice,no improvement in 8 cases.19 cases underwent surgery,of which 16 cases improved but 3 failed.The total death rate was 22 2%,improvement rate 35 5%,cure rate 8 8% and failure 33 3%.Conclusions:The fracture of cervical vertebral body,whether with or without paraplegia,is one of the most severe damages in orthopedics.Its treatment should depend on the severity of fracture,and every effort should be made to decrease the death rate.