Clay-shoveler's骨折合并颈髓损伤的诊断与治疗

The diagnoses and treatment of Clay-shoveler's fracture combined with cervical cord injury

目的探讨Clay-shoveler's骨折合并颈椎脊髓损伤的临床表现、影像学特点、诊断及治疗方法。方法回顾性分析2005年4月至2011年3月收治的8例Clay-shoveler's骨折合并颈椎脊髓损伤患者的临床资料并复习相关文献,总结该骨折合并颈髓损伤的特点。结果所有患者术前均有颈胸段疼痛,特点是卧床休息时疼痛明显减轻或消失,坐或行走时疼痛复发。X线或CT检查可见颈胸段棘突骨折。MRI显示颈椎间盘突出压迫相应节段脊髓。术后患者疼痛均明显减轻或消失,神经损伤症状明显好转。结论虽然Clay-shoveler's骨折发病率较低,但是患者可合并出现颈椎脊髓或神经根损伤的情况。若保守治疗无效常需要手术干预,颈后路棘突固定重建术是较好的治疗方法之一。根据患者的临床表现和影像学特点,决定是否联合颈前路减压植骨融合内固定术。

Objective To investigate the clinical manifestation, imaging character, diagnosis and treatment for patients with Clay-shoveler＇s fracture combined with cervical cord injury. Methods Analyze the clinical datas of 8 patients who suffered Clay-shovelerg fracture combined with cervical cord injury throughout a 6 years period （2005-2011） and reviewed related literature, and then summarized the character of this kind of injury. Results All the patients suffered pain in the neck and chest, the pain disappeared or relaxed when the patients lied down for rest and recrudesce when sitting or walking. Fractures of cervical and thoracic vertebra can be found under X-ray or CT scan exams. The MRI showed that disk herniation of cervical formed and relevant spinal cord was under pressure. The pain disappeared or after relaxed after surgery and neural symptom ameliorated. Conclusions The occurrence of Clay-shoveler＇s fracture was rare, but it＇s clear that it sometimes occurred combine with the injury of cervical cord or nerve root. Surgical treatment is helpful when the expectant treatment failed. Whether the anterior cervical decompression and fusion should be chosen should according to the clinical manifestation and imaging character of the patients.