小结
定义
病史和体格检查
关键诊断因素
- 复合损伤机制
- 颈疼痛
- 危险因素
其他诊断因素
- 意识水平降低
- 肢体感觉异常
- 运动无力
- 感觉缺失
- 直肠或膀胱功能障碍
- 阴茎异常勃起
- 颅神经功能缺失
- 霍夫曼征
- 巴宾斯基征
危险因素
- 男性
- 女性(颈椎挥鞭伤)
- 18 至 25 岁或 >65 岁
- 存在危险性损伤机制
- 分散注意力的(distracting)外伤
- 缺乏准备或无意识状态下发生碰撞事故
- 在发生碰撞事故时头部出现扭转
- 颈椎损伤史或手术史
- 之前有脊柱、头颅或其他发育性异常者
诊断性检查
首要检查
- 高分辨率颈椎 CT
需考虑的检查
- 全脊柱 CT
- 颈椎 MRI
治疗流程
疑似颈椎损伤
已确诊颈椎损伤
单纯颈部扭伤或挥鞭伤
撰稿人
专家顾问
Muhammad Dherijha, MBBS, MRCS
ST8 Neurosurgery
Health Education Northwest
Manchester Clinical Neuroscience Centre
Salford
UK
利益声明
MD declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Christopher S. Ahuja, MD
Research Fellow
Division of Neurosurgery
Department of Surgery
University of Toronto
Ontario
Canada
Michael G. Fehlings, MD, PhD, FRCS(C), FACS
Professor Division of Neurosurgery
Director of Neuroscience Program
University of Toronto
Krembil Chair in Neural Repair and Regeneration
Medical Director
Krembil Neuroscience Center
Toronto Western Hospital
Ontario
Canada
利益声明
CSA declares that he has no competing interests. MGF served as a consultant for Zimmer, In Vivo Therapeutics, and Pfizer. He receives institutional fellowship grant support from AOSpine, Medtronic, and Depuy-Synthes.
同行评议者
Jonathan Lucas, MBBS, FRCS (Eng), FRCS (Orth&Tr)
Head of Service - Paediatric Spinal and Orthopaedic Surgery
Consultant Spinal Surgeon
Guys and St Thomas’ NHS Foundation Trust
Evelina London Children’s Hospital
Guys Hospital
London
UK
利益声明
JL is an Education Consultant to Nuvasive Inc. in the subject of paediatric spinal deformity surgery.
编辑
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Susan Mayor
Lead Section Editor, BMJ Best Practice
利益声明
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
利益声明
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 非创伤性颈椎疼痛
- 颈椎退行性病变
- 获得性斜颈
更多 鉴别诊断指南
- 头部损伤:评估和早期管理
- 脊柱损伤:评估和初始管理
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格拉斯哥昏迷量表
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