急性中央型颈髓损伤综合征的临床治疗

Clinical therapy of acute central cervical spinal cord injury syndrome

目的 探讨急性中央型颈髓损伤综合征的临床治疗。方法 对 30例急性中央型颈髓损伤综合征患者 ,根据病情分别采取保守治疗、颈椎前路、后路脊髓减压手术。结果 平均随访 4年 8个月 ,根据ASIA分级标准 ,在 2 1例非手术治疗组中 ,治疗前B级 1例 ,C级 5例 ,D级 15例 ,治疗后恢复至D级者 4例 ,恢复至E级者 15例 ,无明显恢复者 2例 ;在 9例手术治疗组中 ,治疗前B级 2例 ,C级 4例 ,D级 3例 ,治疗后恢复至C级者 1例 ,恢复至D级者 3例 ,恢复至E级者 4例 ,无明显恢复者 1例。结论 对于MRI显示脊髓无明显受压的患者 ,经保守治疗多可取得满意疗效。对于MRI显示脊髓明显受压的患者 ,行颈椎前、后路脊髓减压手术 。

Objective To investigate the clinical therapy of acute central cervical spinal cord injury syndrome. Methods Thirty cases of acute central cervical spinal cord injury syndrome were selected in this study. Conservative methods and operations through anterior or posterior approach decompression were used according to the state of the illness. Results In 56 months follow-up, extremities functions of 30 patients in this group were all improved to varied degrees. According to ASIA grading system, the 21 cases of conservative treatment, which included grade B 1 case, C 5 cases and D 15 cases, recovered to grade D 4 cases, E 15 cases, and 2 got no recovery; the 9 cases of operative treatment, which included grade B 2 cases, C 4 cases and D 3 cases, recovered to grade C in 1 case, D 3 cases and E 4 cases, and 1 got no recovery. Conclusion Satisfactory therapeutic effects could be obtained with conservative methods in the cases that MRI does not show any obvious compression on spinal cord. Operations through anterior or posterior approach are helpful to the recovery of spinal cord functions in the cases that MRI shows certain compression on spinal cord.