老年脊髓型颈椎病患者脊髓功能受损特征:84例回顾性分析

Characteristics of spinal cord function damage in aged patients with cervical spondylotic myelopathy:a retrospectire analysis in 84 cases

目的:探讨老年脊髓型颈椎病患者的脊髓功能受损特征及干预方式。方法:哈尔滨医科大学第二临床医学院脊柱外科1999-01/2003-12获得随访的脊髓型颈椎病患者84例,根据患者年龄分为老年组和对照组,进行回顾性研究。对两组患者的围手术期表现、临床表现及影像学表现等方面进行对比。结果:与对照组相比,老年组患者多有其他系统伴发疾病。两组患者术前、术后的日本矫形外科学会(JOA)评分,老年组为(6.2±3.2)分和(10.7±2.9)分;对照组为(9.0±3.3)分和(13.1±3.5)分。两组患者的轮替运动速度(AMR)老年组为(11.7±3.6)分和(16.8±4.2)分;对照组为(13.9±4.2)分和(19.5±5.1)分。术后结果均有明显改善(P<0.01),但老年组不如对照组。影像学资料显示,老年组中存在椎间不稳的患者(15/22)明显多于对照组(11/62)。结论:老年脊髓型颈椎病患者围手术期多合并有其他系统疾病。椎间不稳可能是老年脊髓型颈椎病的重要发病机制之一。合理的干预方式选择及正确的围手术期处理是取得满意疗效的关键。

AIM: To investigate the characteristics of spinal cord function damage and the interventional methods in aged patients with cervical spondylotic myelopathy (CSM). METHODS: A retrospective study was conducted in 84 CSM patients, who were followed up in the Department of Spine Surgery, Second Affiliated Hospital of Harbin Medical University from January 1999 to December 2003. The patients were divided into aged group and control group according to their age. The perioperative, clinical and imaging manifestations of patients in the two groups were compared.RESULTS: Compared with the control group, patients in the aged group were accompanied by more diseases of other systems. Japanese Orthopedic Association (JOA) scores before and after operation in the aged group were (6.2± 3.2) and (10.7± 2.9), and those in the control group were (9.0± 3.3) and (13.1± 3.5). Alternative motion rates (AMR) before and after operation were (11.7± 3.6) and(16.8± 4.2)poits in the aged group, but(13.9± 4.2) and (19.5± 5.1) poits in the control group, there were obvious improvements in both groups after operation(P< 0.01), and it was more remarkable in the control group. The imaging data showed that the incidence of intervertebral instability in the aged group (15/22) was remarkably higher than that in the control group (11/62).CONCLUSION: Aged CSM patients are often accompanied by more diseases of other systems during the perioperative period. Intervertebral instability may be one of the important pathogenesis of CSM in aged patients.The reasonable interventional methods and correct treatments during perioperative period are the keys to satisfactory results.