Guo Zhao-qing, Chen Zhong-qiang, Li Wei-shi, Qi Qiang, Ma Qing-jun, Liu Zhong-jun, Dang Geng-ting
Department of Orthopaedics, Peking University Third Hospital, Beijing 100083, China.
Zhonghua Wai Ke Za Zhi. 2006 Feb 15;44(4):238-41.
To study the clinical characteristics and treatment of flexion-distraction stage I injuries in subaxial cervical spine.
Twelve cases of flexion-distraction stage I injuries with delayed symptoms, admitted in our hospital between January 1995 and December 2004, were studied retrospectively. In acute phase, all of 12 cases had neck pain and limited neck movements, neurological deficits were found in 6 of 12 cases. Eight cases had a correct diagnosis, and 2 cases had a error diagnosis, 2 cases missed. All cases were satisfactory by the primary conservative treatment. After 274 days average asymptomatic intervals, all of 12 cases had recurrence of neck pain, delayed neurological deficits were found in 10. MRI showed that all of 12 cases were unstable injuries.
All of the 12 patients were treated operatively. Decompression, fusion and fixation were performed by anterior approach in 9 cases, and by combined anterior and posterior approach in 3 cases. The average follow-up period was 33.1 months. Neck pain had great recovery in all cases, 10 cases with neurological deficits, 7 returned normal. Radiographic evidences of intervertebral bony fusion and good cervical alignment were observed in all of 12 cases.
Flexion-distraction stage I injuries is often caused by ligament and disc injuries, and often missed with subtle symptoms and radiographic changes. Inadequate primary treatment options are often due to failure to recognize the instability, and maybe result in delayed injuries. MRI is helpful for the early accurate evaluation of spinal stability. Unstable injury require early surgical treatment. The anterior approach operation is recommended to most of these patients with acute and old injuries. Combined anterior and posterior approach operation should be considered in these patients who have old injuries with stiff kyphosis.
研究下颈椎屈曲-牵张型Ⅰ度损伤的临床特点及治疗方法。
回顾性分析1995年1月至2004年12月我院收治的12例有延迟症状的下颈椎屈曲-牵张型Ⅰ度损伤患者。急性期，12例均有颈部疼痛及颈部活动受限，12例中有6例出现神经功能缺损。8例诊断正确，2例误诊，2例漏诊。所有病例经初步保守治疗后均获满意效果。平均无症状间隔274天后，12例均再次出现颈部疼痛，10例出现延迟性神经功能缺损。MRI显示12例均为不稳定损伤。
12例患者均接受手术治疗。9例行前路减压、融合及内固定，3例行前后联合入路手术。平均随访33.1个月。所有病例颈部疼痛均有明显恢复，10例有神经功能缺损者，7例恢复正常。12例均见椎间骨性融合及颈椎排列良好的影像学证据。
下颈椎屈曲-牵张型Ⅰ度损伤常由韧带及椎间盘损伤引起，症状及影像学改变轻微时常易漏诊。初步治疗方案不当常因未认识到不稳定性，可能导致延迟性损伤。MRI有助于早期准确评估脊柱稳定性。不稳定损伤需早期手术治疗。对于大多数急性及陈旧性损伤患者，推荐前路手术。对于有陈旧性损伤伴僵硬后凸畸形的患者，应考虑前后联合入路手术。
