无骨折脱位型颈脊髓损伤的病因与手术疗效观察

The pathogeny and surgical curative effect of cervical spinal cord injury without fracture and dislocation

目的探讨无骨折脱位型颈脊髓损伤的病理基础 ,评价不同手术方法的治疗效果。方法回顾 2 2例分别采用了前路减压、植骨、内固定或后路单开门椎管扩大成形术的无骨折脱位型颈脊髓损伤病例 ,分析其术前影像学资料 ,探讨病理实质 ;根据术前、术后Frankel分级情况及影像学的变化 ,判断手术疗效。结果 2 2例无骨折脱位型颈髓损伤病例中 ,过伸型损伤 16例 (6 2 .7% ) ,退变性椎管狭窄 15例 (6 8.2 % ) ,先天性椎管狭窄 4例 (18.2 % )。前路手术患者随访见内置物无松动、脱落或断裂 ,固定节段均获得骨性融合 ;后路手术患者术后X线正位片显示无再关门现象。 14例患者术后MRI检查显示 ,椎管容积扩大 ,颈髓受压缓解。 3例术后脊髓功能无改善 ,其余病例均有不同程度恢复。结论颈椎椎管狭窄是无骨折脱位型颈脊髓损伤的重要病理基础 ,颈髓过伸性损伤是发生四肢瘫的直接原因。只要术式选择合理、手术操作正确 ,前。

Objective To explore the pathology and evaluate the effect of different surgical treatments for cervical spinal cord injury without fracture and dislocation. Methods 22 cases of cervical spinal cord injury without fracture and dislocation underwent anterior decompression, autologous bone graft, internal fixation and laminoplasty by expanding vertebral canal through posterior approach. Their radiological datas were analysed to explore the pathology. Surgical curative effect was evaluated by Frankel criterion and radiological change preoperatively and postoperatively. Results In the 22 cases, there were 16 cases(62.7%)with ultraextension injury, 15 cases(68.2%) with degenerative spinal stenosis, and 4 cases (18.2%)with congenital spinal stenosis. During the follow up, internal fixation instruments were not seen loosen, decidued and broken, and the fixative segments all acquired fusion in the cases treated through anterior approach; the cases treated through posterior approach did not acquired closure by postoperative X ray film. 14 cases with cervical spinal cord compressed were relieved by postoperative MRI. The spinal cord function of the other cases were improved in different degrees except 3 cases based on Frankel criterion. Conclusion Cervical spinal stenosis is the main pathological basis to cervical spinal cord injury without fracture and dislocation, and ultraextension injury is the immediate cause of quadriplegia. As long as the choice of surgical approach and the procedure are correct, the spinal cord function can acquire an optimal recovery both through the anterior and posterior approach.