上頸椎病變分析研究

Assessment of Ipper Cervical Lesion

許書業(Sheu-Yeh Shu) ； 周崇頌(Chorng-Sonq Chou)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 27-31

摘要

在復健科門診中，頸椎病變患人數極多，其中大部分都是下頸椎病變，而發生在上頸椎（沈骨，第一頸椎，第二類頸椎）病變病患人數，則屬少數，往往容易被忽略，而延遲診斷、治療。根據病人頸部受傷機轉，臨床症狀，再利用對關節之各種終末端感覺，再加上image study，能使得平均診斷延遲時間縮短。同時介紹利用上述方法，使得病人在第一次門診時，便有正確診斷之二病例。

並列摘要

Neck pain is the most clinical complain in PM&R out patient department. In spite of , the upper cervical is rare. But the lesion is variety and dangerous.
The upper cervical lesion, non-pathologic lesion is always obviously traumatic history. But pathologic lesion has not obviously traumatic history that the diagnosis is often delayed.
This study was carried out on 68 cases (age 3-76, M/F 51/17) who took CT or MRI at TAICHUNG VETERAN GENERAL HOSPITAL from SEP. 1983 to NOV. 1991. These cases consisted 51 male, 17 female. According to the final results, non-pathologic change 9/68 pathologic 59/68. There were three causes distribution of the non-pathologic change 9/68 pathologic 59/68. There were Three causes distribution of the non-pathologic change, traffic adccident 41/59 falling down 13/59, others 5/59.
Analysis of the total numbers from the delayed time of diagnesis. There were pathologic change 0.8 month, non-pathologic change 6.7 months. obvious traumatic history 8.2 months. in the clinical symtoms, include headache 22/68 (34.2%), neck pain 68/68 (100.0%), radiation pain 16/68 (23.6%), cord compression 16/68 (7.9%).
In the series of the study of the upper cervical lesion, there were two method of physical examination that could exactly find out some problems before image study. The first method is Fryette's three principle described the spinal movements of three dimension. The second method is end feel of joint ROM.
We concluded the detailed history, physical examination and image study. That will be early disgnosis lead to better prognosis.