轻中型颅脑损伤合并上颈椎骨折的外科治疗

发布时间：2018-06-28 04:47

  本文选题：颅脑损伤 + 颈椎损伤　； 参考：《中国矫形外科杂志》2017年20期

【摘要】：[目的]总结轻中型颅脑损伤合并上颈椎骨折的手术治疗经验,以提高对颅颈联合伤的认识。[方法]2008年6月~2012年6月本院手术治疗颅脑损伤合并上颈椎骨折患者46例,对其中无颈髓损伤的22例进行回顾性分析,男13例,女9例,年龄23~68岁,平均41岁。致伤原因:交通伤12例,高处坠落伤7例,暴力及其他伤3例,进行格拉斯哥预后评分(GOS),术后随访X线或CT片评价骨折愈合、植骨融合及颈椎稳定性情况。[结果]入院格拉斯哥评分(GCS)12~14分10例,9~11分12例。均有不同程度脑挫裂伤、硬膜外血肿、硬膜下血肿、脑内血肿;其中合并齿突骨折7例,Jefferson骨折5例,枢椎椎弓骨折4例;寰枢椎复合骨折6例。早期颈椎骨折漏诊3例。12例颅内血肿行开颅手术,3例一期联合颈椎手术,19例二期行颈椎手术。22例均行手术治疗,术中无明显并发症。随访12~36个月,平均18个月。出院GOSⅣ级3例,Ⅴ级19例,枕部放射痛、颈部活动受限等临床症状均减轻,术后复查X线片示骨折愈合良好,颈椎稳定,无内固定松动、脱出及断裂。[结论]颅颈联合伤在临床上并不少见,应重视颅脑损伤患者的颈部检查及保护。早期脑外科与骨科同台手术可取得较好的疗效。
[Abstract]:Objective: to summarize the experience of surgical treatment of mild and moderate craniocerebral injury combined with fracture of upper cervical vertebra in order to improve the understanding of combined craniocervical injury. [methods] from June 2008 to June 2012, 46 cases of craniocerebral injury complicated with fracture of upper cervical vertebra were treated by operation in our hospital. Among them, 22 cases without cervical spinal cord injury were analyzed retrospectively. There were 13 males and 9 females, aged 2368 years, with an average age of 41 years. The causes of injury included traffic injury (n = 12), falling injury (n = 7), violence and other injuries (n = 3). Glasgow prognosis score (GOS) was used to evaluate fracture healing, bone graft fusion and cervical spine stability. [results] Glasgow score (GCS) was 12 ~ 14 in 10 cases and 9 ~ 11 in 12 cases. There were different degrees of cerebral contusion, epidural hematoma, subdural hematoma and intracerebral hematoma, including 7 cases with dentoid process fracture, 5 cases with Jefferson fracture, 4 cases with axial arch fracture and 6 cases with atlantoaxial complex fracture. 3 cases of early cervical fracture missed diagnosis. 12 cases of intracranial hematoma underwent craniotomy 3 cases combined with cervical surgery in 19 cases. 22 cases were treated with cervical surgery without obvious complications. The follow-up was 12 ~ 36 months (mean 18 months). The clinical symptoms such as occipital radiation pain and limited cervical movement were relieved in 3 cases of GOS 鈪，

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