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
- 骶髓保留
- 合并其他创伤性损伤
- 颈椎后方压痛
其他诊断因素
- 男性
- 年龄18-25岁
- 意识状态下降
- 肢体麻木、刺痛或肌力下降
- 直肠或膀胱功能障碍
- 运动无力
- 感觉缺失
- 颈椎活动度（ROM）下降或活动时疼痛
- 肛门直肠收缩或肛周感觉消失
- 痉挛状态
- 反射亢进
- 巴宾斯基征
- 霍夫曼征
- 神经源性休克
- 脊髓休克
- 呼吸变化
- 颅神经功能缺失
危险因素
- 男性
- 女性（颈椎挥鞭伤）
- 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
- 颈椎轴位CT和三维重建
需考虑的检查
- 颈椎X线检查
- 颈椎 MRI
- 脊髓造影计算机断层扫描
- CT 血管造影（CTA）和 MR 血管成像（MRA）
- 过屈过伸位X线检查
- 神经传导检查
- 肌电图
治疗流程
急性颈部疼痛伴有神智变化：初诊时即表现
神经损伤可能性较低：最初评估之后
神经损伤可能性较大：在最初评估之后
撰稿人
作者
Christopher S. Ahuja, MD
Research Fellow
Division of Neurosurgery
Department of Surgery
University of Toronto
Ontario
Canada
利益声明
CSA declares that he has no competing interests.
Fan Jiang, MD, FRCS(C)
Clinical Associate
Division of Neurosurgery
Department of Surgery
University of Toronto
Ontario
Canada
利益声明
FJ declares that he has no competing interests.
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
MGF has served as a consultant for Fortuna Fix. MGF is an author of a reference cited in this topic.
鸣谢
Dr Christopher S. Ahuja and Dr Michael G. Fehlings would like to gratefully acknowledge Dr Narihito Nagoshi, Dr Hiroaki Nakashima, Dr David W. Cadotte, and Dr Jefferson R. Wilson, previous contributors to this topic. NN, HN, DWC, and JRW declare that they have no competing interests.
同行评议者
Jwalant Mehta, MS Orth, D Orth, MCh Orth, FRCS (Tr & Orth)
Consultant Orthopaedic and Spinal Surgeon
BMI Werndale Hospital
Carmarthen
Carmarthenshire
UK
利益声明
JM has been provided with educational support for attending conferences by Medtronic, Depuy Spine UK, and Nuvasive.
Alpesh Patel, MD
Assistant Professor
Orthopedic Surgery Operations
Department of Orthopedics
University of Utah
Salt Lake City
UT
利益声明
AP is an author of a reference cited in this topic.
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
- 美国放射学会 (ACR) 适用标准：疑似脊椎创伤
- 头部损伤：评估和早期管理
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