无骨折脱位颈髓挥鞭样损伤的临床特征

Clinical features of cervical spinal cord whiplash injury without fracture or dislocation

背景:无骨折脱位颈髓挥鞭样损伤是一种特殊颈椎、颈髓损伤,其损伤的原因、机制尚存争议,认识其发病机制可为临床诊断和治疗提供重要的理论基础。目的:综述国内外无骨折脱位颈髓挥鞭样损伤的发病机制和诊断治疗方法。方法:应用计算机检索中国生物医学文献数据库、中文科技期刊全文数据库(1975年1月至2011年5月)和PubMed数据库(1950年1月至2011年5月)中与无骨折脱位颈髓挥鞭样损伤有关的文章,检索词为"颈髓挥鞭样损伤、发病机制、影像学、治疗"和"cervical spinal cord whiplash injuries;pathogenesis;imaging;treatment",并限定文章语种为中文和英文。纳入所述内容与颈椎无骨折脱位颈髓挥鞭样损伤定义、发病机制、影像学表现和治疗及预后相关的文章,排除重复性研究。结果与结论:共检索到90篇相关文章,纳入符合要求的38篇文献进行综述。无骨折脱位颈髓挥鞭样损伤是一种特殊的颈椎、颈髓损伤,主要由过伸性和过屈性损伤引起。近年来对无骨折脱位颈髓挥鞭样损伤的进一步研究发现,其定义、发病机制、影像学表现和治疗标准存在不同的分歧。常规X射线和CT检查无阳性发现,MRI检查能降低无骨折脱位型颈髓挥鞭样损伤的误诊率,是一种最佳检查方法。根据损伤机制可选择前路手术、后路手术和前后路联合手术治疗。

BACKGROUND： Spinal cord whiplash injury without fracture or dislocation belongs to special cervical vertebra and spinal cord damage, the causes and mechanism of the damage have been controversial, the recognition of pathogenesis provides important theoretical basis for clinical diagnosis and treatment. OBJECTIVE： To review the domestic and foreign pathogenesis of spinal cord whiplash injury without fracture and dislocation and the clinical study conditions of diagnosis and treatment method. METHODS： Computer was used for reviewing articles in China biological medical literature database, Chinese science and technology journal full-text database （1975-01/2011-05） and PubMed database （1950-01/2011-05） about spinal cord whiplash injury without fracture or dislocation, the key words were ＂spinal cord whiplash injury, nosogenesis, imaging, treatment＂ in English and Chinese, and the language in the article was limited into Chinese and English. The articles that related to the definition, pathogenesis, imaging manifestations, treatment and prognosis of spinal cord whiplash injury without fracture or dislocation, the repetitive articles were excluded. RESULTS AND CONCLUSION： A total of 90 related articles were collected, 38 articles in line with the standards were included. The spinal cord whiplash injury without fracture or dislocation belongs to a kind of special cervical vertebra and spinal cord injury, and is mainly caused by hyperextension and flexion injury. Further study on spinal cord whiplash injury without fracture or dislocation in recent years discovered that definition, pathogenesis, imaging manifestations and treatment standards had differences. Conventional X-ray and CT examination has no positive discovery; MRI examination is the best inspection methods which can reduce the misdiagnosis rate of spinal cord whiplash injury without fracture or dislocation. According to the damage mechanism, the anterior approach, posterior approach and combined surgery of anterior approach and posterior approach can be selected for the treatment.