外伤后迟发型下颈椎创伤性不稳的诊断与治疗改1

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1、外伤后迟发型下颈椎创伤性不稳的诊断与治疗改1创伤后迟发型下颈椎不稳及英初诊时漏诊原因分析唐勇王新伟袁文韩竹刘洋张卫红汤俊君第一作者：唐勇，在读博士，上海长征医院手机：13585632025通讯作者：王新伟上海长征医院，上海市凤阳路415号长征医院骨科6楼。邮编:200003c电话：02181886806c传真:02163720099.电子邮箱：orth.wang@263.netThedelayedpost-traumaticlowercervicalinstabilityandtheanalysis

2、ofit'smisseddiagnosisinpreliminaryvisitTANGYong,WANGXin-wei,YUANWen,etal.DepartmentofOrthopaedics,ChangzhengHospital.TheSecondMilitaryMedicalUniversity,Shanghai,200003,China.Correspondingauthor:WANGXin-wei,Emaikorth.wang@263.net.正文字数：约1900字，共4幅图。【摘要】目的

3、：探讨创伤后迟发型下颈椎不稳及其初诊时漏诊原因。方法：回顾分析12例创伤后迟发型下颈椎不稳病例诊治过程，2例无症状者行保守治疗，并定期复查。其余10例行手术治疗。其中7例仅存在前方椎节不稳，无后方小关节脱位患者行前路间隙减压复位植骨内固定术,2例前方椎节不稳合并严重后纵韧带骨化患者行后路椎管减压侧块螺钉内固定术，1例合并前方椎节不稳及后方小关节绞索，单纯前路手术难以达到满意复位效果的患者行前后联合手术。结果：所有患者平均随访43个月，不稳节段均得到融合稳定。并无不稳再发。患者症状改善明显，JOA评分

4、提高2・4分(平均2.3分)。结论：首诊医生对创伤后迟发型下颈椎不稳症认识不足，故而对初诊无症状或者仅存在轻微症状的颈椎外伤患者诊疗不够细致，从而导致迟发型下颈椎不稳的发生。故对于颈椎外伤急性期的患者，即使其仅存在轻微症状，甚至无任何不适主诉，也需耍仔细查体，进行详细的影像学检查。对高度怀疑存在颈椎不稳可能的患者应叮嘱其定期复查。【关键词】迟发型；下颈椎；创伤性；关节不稳定；漏诊【Abstract]ObjectiveToinvestigatethereasonsofmisseddiagnosisof

5、delayedpost-traumaticlowercervicalinstability.MethodsRetrospectiveanalysisfor12delayedpost-traumaticlowercervicalspineinstability,?ofthemwithnoclinicalsymptomswerereceivedconservativetreatmentssuchasbracingandnon-steroidalanti-inflammatorydrugsandfollo

6、wedupregularly.7ofthemwithmerelyanteriorinstabilitywerereceivedanteriordecompression,bonegraftingandinternalfixation.2ofthemcombinedwithsevereossificationofposteriorIongitudinalligament(OPLL)werereceivedposteriorlateralmassscrewfixation.And1casesuffere

7、danteriorinstabilityandposteriorarticularcablewasreceivedantero-posteriorsurgery.ResultsAllpatientswerefollowedupforanaverageperiodof43months.Solidfusionwasachievedforalloperatedlevels・Thepatientsgotasatisfactoryreliefofpreoperativesymptoms.TheJOAscore

8、wasincreasedby2-4,2.3onaverage.ConclusionsInsufficientconcernofthecervicaltraumapatientsatfirstaidresultedindelayedlowercervicalinstability.Therefore,patientswithcervicalspinetraumarequiredphysicalexaminationcarefully,ifnecessary,toprov