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[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。
[Objective] To summarize the experience of surgical treatment of light and medium-sized craniocerebral injury combined with cervical spine fractures to improve understanding of craniocerebral injury. [Methods] From June 2008 to June 2012, 46 patients with craniocerebral injury and upper cervical spine underwent surgical treatment in our hospital. Twenty-two patients without cervical injury were retrospectively analyzed. There were 13 males and 9 females, aged 23 ~ 68 years old, average 41 years old. Cause of injury: traffic injury in 12 cases, fall injury in 7 cases, 3 cases of violence and other injuries, Glasgow prognostic score (GOS), postoperative follow-up X-ray or CT film evaluation of fracture healing, bone fusion and cervical stability Happening. [Results] The admission of Glasgow score (GCS) 12 to 14 points in 10 cases, 9 to 11 points in 12 cases. There are varying degrees of brain contusion, epidural hematoma, subdural hematoma, intracerebral hematoma; which combined with odontoid fracture in 7 cases, Jefferson fracture in 5 cases, 4 cases of axial pedicle fracture; atlantoaxial composite fracture 6 example. Misdiagnosis of early cervical fracture in 3 cases. 12 cases of intracranial hematoma craniotomy, 3 cases of a combined cervical surgery, 19 cases of two cervical spine surgery. Twenty-two patients underwent surgical treatment without significant complications. Follow-up 12 to 36 months, an average of 18 months. There were 3 cases of GOS Ⅳ grade discharged in 19 cases, 19 cases of grade Ⅴ gonadotropin. All the clinical symptoms such as radiating pain in the occipital region and limited neck movement were relieved. X - ray showed good fracture healing, stable cervical spine, looseness, prolapse and fracture. [Conclusion] The craniocerebral injury is not uncommon in clinic, and the neck examination and protection should be emphasized in patients with craniocerebral injury. Early brain surgery and orthopedic surgery with the same table can achieve better results.