小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 背痛
- 青肿
- 急性麻木或感觉异常
- 无力
- 肌肉痉挛/阵挛（高张力）或张力减低
- 反射亢进或反射减弱
- 霍夫曼征
- 巴宾斯基征呈阳性
- 脊椎畸形
- 肛门括约肌反射能力丧失
其他诊断因素
- 无球海绵体肌反射（S3-S4）
- 脊髓休克症状（张力减低或迟缓，在24小时内消失）
- 尿失禁
- 无痛性尿潴留
危险因素
- 高空跌落
- 机动车碰撞事故
- 年龄 ＞65 岁
- 伴随骨质疏松症
- 既往有椎体骨折
- 潜在的肿瘤性病变
- 潜在代谢病或炎症性疾病
- 男性
诊断性检查
首要检查
- 胸腰椎X线片（前后位及侧位片）
需考虑的检查
- 脊柱 CT
- 脊柱 MRI 检查
- CT 脊髓造影术
- 采用STIR序列拍摄MRI
治疗流程
现场观察：可能是脊柱损伤
骨质疏松性骨折
非骨质疏松性骨折
撰稿人
作者
Besnik Nurboja, BSc, MBBS, MD (Res), MRCS, MCEM
Consultant in Emergency Medicine
Emergency Medicine
Epsom and St Helier University Hospital NHS Trust
London
UK
利益声明
BN declares that he has no competing interests.
David Choi, FRCS(SN)
Consultant Neurosurgeon and Spinal Surgeon
The National Hospital for Neurology and Neurosurgery
London
UK
利益声明
DC declares that he has no competing interests.
同行评议者
Nils Ake Nystrom, MD, PhD
Associate Professor
Department of Orthopedic Surgery and Rehabilitation
Division of Plastic and Reconstructive Surgery
University of Nebraska Medical Center
Omaha
NE
利益声明
NAN is an author of a reference cited in this topic.
David W. Rowed, MD, FRCSC
Professor of Surgery
Division of Neurosurgery
University of Toronto
Physician
Department of Otolaryngology
Sunnybrook Health Sciences Centre
Toronto
Canada
利益声明
DWR declares that he has no competing interests.
Renn Holness, BSC, MBBS (Hons), FRCSC
Professor
Division of Neurosurgery
Dalhousie University & QEII Health Sciences Centre
Halifax
Canada
利益声明
RH declares that he has no competing interests.
Andre Tomasino, MD
Department of Neurological Surgery
Weill Cornell Medical College
New York-Presbyterian Hospital
New York
NY
利益声明
AT declares that he has no competing interests.
鉴别诊断
- 腰背部肌肉骨骼疼痛
- 急性颈椎外伤
- 颈椎退行性病变
更多 鉴别诊断指南
- 有效识别椎骨骨折的临床指南
- 脊柱损伤：评估和初始管理
更多 指南患者教育信息
骨关节炎
骨质疏松症
更多 患者教育信息
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