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ENGLISH ABSTRACT
急性成人无骨折脱位型颈脊髓损伤诊疗指南（2025版）
王庆德
初同伟
董健
杜良杰
冯皓宇
范顺武
冯世庆
高延征
海涌
何达
蒋电明
姜建元
林斌
刘斌
刘宝戈
李放
李锋
李利
李危石
李方财
刘晓光
刘宏建
刘勇
刘忠军
鲁世保
卢旭华
毛克亚
马学晓
邱勇
戎利民
舒钧
宋跃明
孙天胜
王岩
王哲
王征
王冰
王林峰
王宇
王庆贺
吴继功
夏虹
殷国勇
闫景龙
袁文
杨勇
杨强
杨操
赵杰
仉建国
朱悦
朱泽章
周英杰
张忠民
曾岩
郝定均
贺宝荣
梅伟
中国医师协会骨科医师分会脊柱创伤学组
作者及单位信息
·
DOI： 10.3760/cma.j.cn501098-20241107-00644
Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture-dislocation in adults (version 2025)
Wang Qingde
Chu Tongwei
Dong Jian
Du Liangjie
Feng Haoyu
Fan Shunwu
Feng Shiqing
Gao Yanzheng
Hai Yong
He Da
Jiang Dianming
Jiang Jianyuan
Lin Bin
Liu Bin
Liu Baoge
Li Fang
Li Feng
Li Li
Li Weishi
Li Fangcai
Liu Xiaoguang
Liu Hongjian
Liu Yong
Liu Zhongjun
Lu Shibao
Lu Xuhua
Mao Keya
Ma Xuexiao
Qiu Yong
Rong Limin
Shu Jun
Song Yueming
Sun Tiansheng
Wang Yan
Wang Zhe
Wang Zheng
Wang Bing
Wang Linfeng
Wang Yu
Wang Qinghe
Wu Jigong
Xia Hong
Yin Guoyong
Yan Jinglong
Yuan Wen
Yang Yong
Yang Qiang
Yang Cao
Zhao Jie
Zhang Jianguo
Zhu Yue
Zhu Zezhang
Zhou Yingjie
Zhang Zhongmin
Zeng Yan
Hao Dingjun
He Baorong
Mei Wei
Spinal Trauma Group, Orthopedic Surgeons Branch, Chinese Medical Doctor Association
Authors Info & Affiliations
Wang Qingde
Zhengzhou Orthopedic Hospital, Zhengzhou 450052, China
Chu Tongwei
Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Dong Jian
Zhongshan Hospital, Fudan University, Shanghai 200032, China
Du Liangjie
Beijing Boai Hospital, China Rehabilitation Research Center, Beijing 100068, China
Feng Haoyu
Shanxi Bethune Hospital, Taiyuan 030032, China
Fan Shunwu
Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
Feng Shiqing
Second Hospital of Shandong University, Jinan 250033, China
Gao Yanzheng
Henan Provincial People′s Hospital, Zhengzhou 450003, China
Hai Yong
Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
He Da
Beijing Jishuitan Hospital, Beijing 100035, China
Jiang Dianming
Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
Jiang Jianyuan
Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
Lin Bin
13909th Hospital of the Joint Logistics Support Force of the PLA, Zhangzhou 363099, China
Liu Bin
Inner Mongolia Medical University, Hohhot 010110, China
Liu Baoge
Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Li Fang
Seventh Medical Center of PLA General Hospital, Beijing 100026, China
Li Feng
Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
Li Li
PLA General Hospital, Beijing 100853, China
Li Weishi
Peking University Third Hospital, Beijing 100191, China
Li Fangcai
Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
Liu Xiaoguang
Peking University Third Hospital, Beijing 100191, China
Liu Hongjian
First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Liu Yong
Tibet Autonomous Region People′s Hospital, Lhasa 850010, China
Liu Zhongjun
Peking University Third Hospital, Beijing 100191, China
Lu Shibao
Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Lu Xuhua
Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
Mao Keya
PLA General Hospital, Beijing 100853, China
Ma Xuexiao
Affiliated Hospital of Qingdao University, Qingdao 266003, China
Qiu Yong
Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Rong Limin
Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
Shu Jun
Second Affiliated Hospital of Kunming Medical University, Kunming 650106, China
Song Yueming
West China Hospital of Sichuan University, Chengdu 610041, China
Sun Tiansheng
Seventh Medical Center of PLA General Hospital, Beijing 100026, China
Wang Yan
PLA General Hospital, Beijing 100853, China
Wang Zhe
Xijing Hospital, Air Force Medical University, Xi′an 710032, China
Wang Zheng
PLA General Hospital, Beijing 100853, China
Wang Bing
Second Xiangya Hospital of Central South University, Changsha 410012, China
Wang Linfeng
Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Wang Yu
Peking University First Hospital, Beijing 100034, China
Wang Qinghe
Southern University of Science and Technology Hospital, Shenzhen 518055, China
Wu Jigong
Specialty Medical Center of the PLA Strategic Support Force, Beijing 100000, China
Xia Hong
General Hospital of the PLA Southern Theater Command, Guangzhou 510010, China
Yin Guoyong
First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Yan Jinglong
Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Yuan Wen
Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
Yang Yong
Zhengzhou Orthopedic Hospital, Zhengzhou 450052, China
Yang Qiang
Tianjin Hospital, Tianjin 300202, China
Yang Cao
Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, China
Zhao Jie
Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Zhang Jianguo
Peking Union Medical College Hospital, Beijing 100032, China
Zhu Yue
First Affiliated Hospital of China Medical University, Shenyang 110001, China
Zhu Zezhang
Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
Zhou Yingjie
Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou 450046, China
Zhang Zhongmin
Nanfang Hospital, Southern Medical University, Guangzhou 510510, China
Zeng Yan
Peking University People′s Hospital, Beijing 100044, China
Hao Dingjun
Honghui Hospital Affiliated to Xi′an Jiaotong University, Xi′an 710054, China
He Baorong
Honghui Hospital Affiliated to Xi′an Jiaotong University, Xi′an 710054, China
Mei Wei
Zhengzhou Orthopedic Hospital, Zhengzhou 450052, China
Spinal Trauma Group, Orthopedic Surgeons Branch, Chinese Medical Doctor Association
·
DOI： 10.3760/cma.j.cn501098-20241107-00644
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摘要

无骨折脱位型颈脊髓损伤（CSCIWFD）是指临床特征表现为创伤性脊髓功能障碍与影像学无明显骨性结构异常的一种特殊颈脊髓损伤类型，首诊时易漏诊，可能导致进行性神经功能恶化甚至完全性瘫痪，严重影响患者预后。目前，CSCIWFD的诊疗方案尚未达成共识，如非手术治疗的适应证缺乏循证标准，且存在继发性神经损伤风险，而手术治疗的最佳手术时机及不同手术入路的适应证均存在争议。为此，中国医师协会骨科医师分会脊柱创伤学组组织相关领域专家，基于循证医学证据，遵循科学性和实用性原则，制订《急性成人无骨折脱位型颈脊髓损伤诊疗指南（2025版）》，从命名、诊断、评估、治疗及康复等方面提出11条推荐意见，为规范CSCIWFD的诊疗提供指导。

颈椎;脊柱骨折;脱位;脊髓损伤;指南
ABSTRACT

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Cervical vertebrae;Spinal fractures;Dislocations;Spinal cord injuries;Guidebooks
Mei Wei, Email: mocdef.3ab616069iewiem

PREPARE-2024CN958

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引用本文

王庆德,初同伟,董健,等. 急性成人无骨折脱位型颈脊髓损伤诊疗指南（2025版）[J]. 中华创伤杂志,2025,41(03)：243-252.

DOI:10.3760/cma.j.cn501098-20241107-00644

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无骨折脱位型颈脊髓损伤（cervical spinal cord injury without fracture-dislocation，CSCIWFD）是指患者伤后出现颈脊髓损伤的临床症状和体征，但所有影像学检查未发现骨折或脱位表现的一种特殊颈脊髓损伤类型 ［ 1 ］ 。CSCIWFD在国内多见于成人，占脊髓损伤的9%~20%，以过伸性损伤最为常见 ［ 1 , 2 , 3 , 4 ］ 。其症状的严重程度因人而异，其中成人以中央管综合征多见，伤后3~7 d症状最为明显，严重者可致瘫痪，严重影响患者生活质量及生命安全，且患者受伤前多伴有颈椎管狭窄等病理改变，导致患者脊髓有效缓冲空间减少，一旦受到外力作用，甚至摔伤、跌倒等低能量损伤即可造成CSCIWFD ［ 3 , 4 , 5 , 6 , 7 , 8 , 9 ］ 。其临床症状与影像学检查并不完全相符，导致漏诊和误诊率较高 ［ 6 ］ 。CSCIWFD的诊疗方案尚未达成共识，如非手术治疗的方法及适用人群尚无规范性指导意见，不恰当的非手术治疗可能影响神经功能的恢复 ［ 10 ］ 。而在手术治疗方面，何时手术可使患者达到最佳预后，同时前入路、后入路、前后联合入路等手术入路应如何选择，因为错误的手术方式可能导致减压不充分，影响患者神经功能恢复 ［ 11 ］ 。为此，中国医师协会骨科医师分会脊柱创伤学组联合相关领域专家，基于循证医学证据，遵循科学性和实用性原则，制订《急性成人无骨折脱位型颈脊髓损伤诊疗指南（2025版）》（以下简称“本指南”），从命名、诊断、评估、治疗及康复等方面提出11条推荐意见，为CSCIWFD的诊疗提供指导。
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梅伟，Email： mocdef.3ab616069iewiem
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王庆德：资料收集及分析、指南撰写；梅伟：指南制订指导、资料分析及解释、指南修改；其他作者：指南文献筛选、相关推荐意见讨论

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王庆德, 初同伟, 董健, 等. 急性成人无骨折脱位型颈脊髓损伤诊疗指南（2025版）[J]. 中华创伤杂志, 2025, 41(3): 243-252. DOI: 10.3760/cma.j.cn501098-20241107-00644.
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