早期牵引治疗合并于中型颅脑损伤的颈椎损伤

Early cervical vertebra traction in the treatment of moderate TBI accompanying with cervical vertebra injury

目的探讨早期牵引在并发于中型颅脑损伤的颈椎损伤前期救治中的应用与注意事项。方法本院对所有疑似合并有颈椎损伤的颅脑损伤患者均常规予以早期颈部制动。近3年来，急诊科、神经外科、骨科协同，对并发于GCS9～12分的中型颅脑损伤的颈椎损伤患者进行早期颈椎牵引，按照就诊先后随机分组：观察组从接诊或人院时即开始早期颈椎牵引，之后才确诊伴有或排除颈椎损伤；对照组起初仅予以颈托制动，待明确诊断有颈椎损伤后才开始牵引。两组其余诊疗标准（含手术指征等）与治疗方法均相同。结果观察组治疗三周Frankel评分改善程度、伤后6个月GOS评估均优于对照组，差异有统计学意义。结论对合并有颈椎损伤的颅脑损伤患者，除了常规进行开颅手术等治疗之外，早期进行颈椎牵引可以明确改善预后，可以作为后续颈椎手术等措施的有效前期治疗。

Objective To investigate the effectiveness and applications of early cervical vertebra traction in the treatment of moderate traumatic brain injury （TBI） accompanying with cervical vertebra injury. Methods Early positioning was applied to all the patients with brain injury accompanying with cervical vertebra injury or not. In the recent 3 years, the doctors in department of emergency, neurosurgery and orthopedics work together to investigate the effectiveness of early cervical vertebra traction. The patients were randomly assigned to the experimental group and the control group according to odd or even number. Early cervical vertebra traction was applied to the patients in the experimental group as early as on admission, while in the control group, early positioning was first applied and cervical vertebra traction was performed only after the diagnosis of cervical vertebra injury. Other treatment strategies were the same in both groups. Results The Frankel scores at 3 weeks after treatment and the GOS scores at 6 moths were better in the experiment group than the control group, and the differences were significant. Conclusion Early cervical vertebra traction is an effective treatment to improve the prognosis for the patient with brain injury accompanying with cervical vertebra injury, despite the routine treatments including of craniotomy. It＇ s benefit for the further treatment of cervical vertebra injury.