外傷性頸部症候群—診断・治療・予後判定に関する検討

THE TRAUMATIC CERVICAL SYNDROME:A diagnosis and treatment

I．はじめに

　昭和41年4月，われわれの大学で脳神経外科が新設されて以来，昭和42年7月までにわれわれの教室で取扱つた頭部外傷例ならびに頸部外傷例は全部で1,468例で，その内訳は第1表のごとくである。ここでいわゆる「むちうち損傷」とはDavis^1）（1945），Gay　＆　Abbot^2）（1953）らのいう，頸の急激な過伸展，過屈曲，側屈曲などを起こす損傷をいつているのであつて，それに伴つて頭部を打撲している例は「むちうち損傷および頭部外傷群」にいれているのである。われわれはこれらの症例の診断や治療につき，以下に述べるごとく，種々の検討を行なつた。

589 patients with cervical syndrome have been treated by a definite program in Kansai Medical College Hospital since April 1966. Results of this series were reviewed, with special emphasis on pos-sible mechanism and treatment of incurable cases.

A treatment program for traumatic cervical syn-drome in acute stage, which we consider arbitrarily about one month, principally comprized local rest and uses of antiinflammatory drugs and/or analgesics, frequently immobilization with a collar according to the severity of symptoms. Later on nerve blocks and traction were added depending upon their sym-ptoms. At the same time instructions and suggestions for suitable jobs or desirable kinds of work were individually given to each patient.

By correlating X-ray findings to follow-up results for selected 161 cases, from which extraordinarily prolonged cases were excluded, it was found that patients with X-ray changes such as an obvious localized abnormal curvature of the cervical spine, angulation, subluxation and/or narrowing of interver-tebral foramina, had suffered longer than those with-out X-ray changes. Therefore, X-ray findings were considered helpful for judging prognosis in most cases.

In incurable cases, however, there was neither difinite correlations between severity of symptoms and X-ray findings, nor definite course of illness. Patients showed a variety of symptoms and con-siderable fluctuations of their intensity throughout entrie course of illness, and it was shown by MMPI-test (Minesota Multiphasic Personality Inventory) and examinations by psychiatrists that psychic factors played an important role in the development of their symptoms. It was also shown that these patients had an increased sensitivity to both adrenalin and pilocarpin tests.

We have proposed the modified treatment program for the traumatic cervical syndrome, based on the present study, in order to provide a better prognosis and to reduce an incidence of incurable cases.