颈椎过伸性损伤的手术方式探讨

Exploration of approach in surgery for cervical hyperextension injury

目的探讨过伸性颈椎颈髓损伤后合理的手术方式。方法对67例过伸性颈椎颈髓损伤接受手术患者进行回顾性分析,根据手术方式不同分成3组:前路、后路、前后联合入路,比较其疗效差异。结果经过6-12个月的随访,比较3组间手术前后的Frankel的分级变化和ASIA评分改变。结果显示,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,两组间差异明显;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相似。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,后路作为次选的手术入路选择,联合入路应根据具体的病情,严格掌握手术指征。

Objective To explore the reasonable approach in surgery for cervical hyperextension injury. Methods Sixty-seven patients of hyperextension injury of cervical spine, 31 males and 16 females, aged 41 - 57, underwent surgery via anterior approach （ n = 25 ） , posterior approach （ n = 27 ） , or combined approach （n = 13） according to the different operation methods 8 days （3 days - 3 weeks） after the injury and then followed up for 6 ～ 12 months. The therapeutic effects were compared. ResultsAfter the operation, the Frankel grade was ascended in all patients of the anterior approach group, and was descended in some patients in the posterior approach and combined approach groups. The ASIA grade of the anterior approach and combined approach groups were both ascended in comparison with that of the posterior approach group （ both P 〈 0. 05 ） however, there was not significant difference between the anterior approach and combined approach groups. Conclusion Anterior decompression-graft-internal fixation is the preferred consideration to treat hyperextension injury of cervical spine, and posterior one is only the secondary choice. Combined approach should be stricdy selected according to the concrete situation.