无骨折脱位颈椎外伤后迟发性神经损伤的诊治

Analysis of diagnosis and treatment for delayed symptoms of nerve injury after cervical trauma

目的探讨无骨折脱位颈椎外伤后迟发性神经损伤发生机制以及诊治方法。方法回顾性分析自2008-01—2013-10收治的27例无骨折脱位颈椎外伤伴迟发性神经损伤的临床资料。所有患者就诊时给予常规X线和CT检查,颈部不适症状较重者或出现神经症状者给予颈椎MRI检查。所有患者先行非手术治疗,非手术治疗效果不佳者给予手术治疗。结果 3例颈椎外伤患者未及时就诊,其余24例急诊行颈椎X线检查,其中7例椎前筋膜增厚,22例颈椎生理曲度异常;21例行急诊CT检查均未见明显颈椎骨折,其中11例局部节段椎前筋膜增厚。22例在外伤3周内行颈椎MRI检查,12例存在椎间盘明显突出伴脊髓受压;5例在外伤3周后行颈椎MRI检查都存在椎间盘明显突出伴脊髓受压,4例行第2次颈椎MRI复查显示椎间盘明显突出伴脊髓受压。经非手术治疗6例患者恢复正常,21例行颈椎前路手术治疗。9例颈椎外伤3周内手术,术中见颈长肌水肿或充血。12例颈椎外伤3周后手术,术中可见后纵韧带和椎间盘存在一定粘连或钙化。21例手术患者JOA评分:术前平均(24.1±0.9)分,术后6周平均评分(26.2±0.7)分。结论颈椎外伤引发的颈椎稳定性结构损伤是导致继发神经损伤的重要原因。颈椎外伤后早期检查和早期治疗是减少迟发性神经损伤的重要方法。

Objective To investigate the mechanisms of delayed symptoms of nerve injury after cervical trauma and treatment. Methods From Jan. 2008 to Oct. 2013, 27 patients with delayed symptoms of nerve injury after cervical trauma treated in our hospital were retrospectively reviewed. All patients underwent X ray, CT and MRI, and operations when conservative treatment failed. Results Twenty four patients received X ray, which showed that there were significantly thicker prevertebral fascia in 7 patients, abnormal neck curve in 22 patients. Twenty one patients received CT, which showed there were no vertebral fractures in any patients and significantly thicker prevertebral fascia in 11 patients. Twenty two patients received MRI in 3 weeks after cervical trauma, among which there were cervical disc herniation combined with spinal compression in 12 patients. Five patients received MRI 3 weeks after cervical trauma, there were cervical disc herniation combined with spinal compression in all 5 patients. Four patients received second MRI, which showed that there were higher degree of disc herniation and spinal compression. Six patients recovered by conservation treatment. Twenty one patients underwent anterior cervical depression and fixation operation. There was edema or congestion in musculi longus cervicis in 9patients with operation time in 3 weeks after cervical trauma. There were significant adhesion between posterior longitudinal ligaments and cervical disc in 12 patients with operation time at 3 weeks after cervical trauma. The mean preoperational JOA value of nerve symptom of patients were 24.1 ±0.9 and the value of 6 weeks after operation were 26.2 ±0.7. Conclusion Damage of stability of cervical vertebral is the important reason for delayed symptom of nerve injury. Early examination and treatment are a good way to diminish the delayed symtoms of nerve injury.