后路减压及内固定手术治疗合并脊髓损伤的多节段脊柱不稳的疗效观察

Operation of Decompression and Internal Fixation from the Posterior Approach for Treating Multiple Levels Spinal Instability complicated with Spinal Cord Injury

目的探讨和学习脊柱各节段后路手术的内固定装置技术治疗因多种原因所致的伴不同部位脊髓损伤的多节段脊柱不稳,并观察其疗效。方法特性化各个不同节段脊柱后路的开窗减压、内固定和融合技术治疗69例此类病例,包括暴力性急性多节段脊柱骨折、慢性多节段椎管狭窄和外伤后的先天性颈椎和颅底凹陷畸形等三种情况。术后随访1～3年,术前和术后随访的脊髓损伤情况按ASIA的标准作分级和疗效分析。结果52例病人完全恢复。9例绝大部分恢复。4例需扶杖行走。2例全瘫病人恢复不理想。1例仍全瘫。1例半年死亡。其治愈率和基本治愈率分别是75%和13%,总有效率88%。结论该技术对多节段脊柱不稳治疗有效,特别对伴有不完全性脊髓损伤病例。

Objective To study the treatment techniques of multiple levels spinal instability complicated with spinal cord injury induced by various factors using opertation of decompression and internal fixation from the posterior approach, and observe their effects. Methods 69 cases of multiple levels spinal instability complicated with spinal cord injury resulting from the acute fractures of violent force, the chronic multiple levels vertebral cavity stenosis and congenital cervical vertebral deformity were treated with the techniques mentioned above. All the patients were followed up for 1 to 3 years after operation. The injury degree of spinal cord was graded according to ASIA's standards before and after operation, and operative efficacy was evaluated. Results 52 cases completely recovered, 9 mostly recovered, and 4 went about on crutches. Among 2 cases of paralysis patients, 1 still was complete paralysis and the other one died. The total efficacious rate was 88%. Conclusion Operation of decompression and internal fixation was effective for treating multiple levels spinal instability, especially for complicated with an incomplete spinal cord injury.