过伸性颈椎颈髓损伤的手术入路疗效比较

Operative methods for cervical hyperextension injuries

目的探讨过伸性颈椎颈髓损伤后三种手术入路疗效的比较。方法我们对2000年9月～2004年10月间收治的47例过伸性颈椎颈髓损伤并接受手术治疗的患者进行回顾性分析,根据手术方式不同分成三组:前路入路组、后路入路组、前后联合入路组,比较其疗效。结果所有患者经6～12个月随访,比较三组间手术前、后的Frankel的分级变化和ASIA评分改变。三组术后神经功能均较术前有明显改善;前路减压、植骨内固定和前后联合入路减压、植骨内固定均较后路减压、植骨内固定术后神经功能恢复好,两两间差异有显著性意义(P<0.05);前后联合入路减压最彻底,但其预后与单纯前路减压内固定差异无显著性意义(P>0.05)。结论前路减压内固定是过伸性颈椎颈髓损伤首选的手术方式,后路是辅助的手术方法,而前后联合入路应谨慎选用。

Objective To explore rational operative methods to treat hyperextension injuries of cervical spine. Methods 47 cases of hyperextension injury of cervical spine were treated in our department from September, 2000 to October, 2004. They were followed up and analyzed retrospectively. According to the operative methods, there were 3 groups： anterior approach, posterior approach, combined approach. Their therapeutic effects were compared respectively. Results After follow-ups for 6 to 12 months, preoperative and postoperative Frankel classifications and ASIA （American Spinal Injury Association） grades were compared between the 3 groups. It was found that neural function improved significantly in the 3 groups after operation. The anterior approach and combined approach groups had significantly better outcome in neural function than the posterior approach group （ P 〈 0. 05）. The combined group had the fullest decompression, but its prognosis was not significantly different from that of the anterior approach group（ P 〉 0. 05）. Conclusions Anterior decompression-graft-internal fixation is the preferred consideration to treat hyperextension injury of cervical spine, and the posterior approach is only the secondary choice. The combined approach should be carefully selected under appropriate conditions.