无骨折脱位型颈髓损伤的手术治疗

Operative treatment of the cervical spinal cord injury without fracture or dislocation

目的探讨无骨折脱位型颈髓损伤的病理基础、手术方法的选择和治疗效果。方法对20例采用手术治疗的无骨折脱位型颈髓损伤患者进行回顾分析,并根据不同的特点采用不同的手术方式,观察近期疗效。结果20例无骨折脱位型颈髓损伤患者中,退变性椎管狭窄13例(65%),节段性不稳6例(30%)。以颈椎间盘脱出为主要表现7例(35%);存在各种原因所致的椎管储备间隙明显减少或消失的病理基础7例(35%);在椎管储备间隙明显减少或消失的病理基础上,伴有节段性椎间不稳或椎间盘脱出6例(30%)。20例术后随访9～84个月,平均36.5个月。前路手术固定节段均获骨性融合,内固定物无松动,断裂;后路手术无再关门现象。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,其余患者均有不同程度恢复。结论颈椎椎管狭窄是无骨折脱位型颈髓损伤的重要病理基础;合理选择术式,手术操作正确,前、后路手术均能获得较理想的脊髓功能恢复效果。

Objective To explore the pathological basis, the selection of operative method and operative result for cervical spinal cord injury without fracture or dislocation. Methods A retrospective study was performed on 20 cases of cervical spinal cord injury without fracture or dislocation treated surgically and short-term outcomes were evaluated upon different surgical operations that were performed accordingly. Results Of all, 13 (65%) cases were with degenerative cervical canal stenosis, six (30%) with segmental instability, seven (35%) with typical cervical disc protrusion or prolapse, seven (35%) with obviously decreased or disappeared storing space of cervical canal and six (30%) with decreased or disappeared storing space of cervical canal as well as segmental instability or cervical disc prolapse. All cases were followed up for 9-84 months (average 36.5 months). All segment with anterior fixation attained solid fusion, without implants loosening or breakage. No reclosed open-door was found in the posterior laminoplasty. The postoperative MRI showed that the cubage of cervical canal expanded and the compression of spinal cord relieved. The myeloid function recovered at different extents in all cases except for three that had little improvement. Conclusions Cervical canal stenosis is the main pathological basis of the cervical spinal cord injury without fracture or dislocation. If operative method is proper and operative process accurate, either anterior or posterior approach can achieve good myeloid functional recovery.