颈椎颈髓损伤后外科干预时间对神经功能恢复的影响(英文)

Effect of surgical intervention time on nervous function recovery after cervical spinal cord injury

背景:脊髓损伤后决定预后的两个主要因素为损伤当时外力的大小和脊髓受压的时间。前者不能改变,而对于后者却可以通过尽早解除脊髓压迫来促进神经功能的恢复。目的:比较颈椎颈髓损伤后72h内与10～14d内进行外科干预后神经功能恢复的情况。设计:随机对照及前后对照观察。单位:哈尔滨医科大学附属第二医院脊柱外科。对象:选择1998-04/2001-08哈尔滨医科大学附属第二医院脊柱外科入院的颈椎脊髓外伤患者32例。严格按随机交替原则被分为早期手术组(损伤后72h内)16例,男10例,女6例;择期手术组(损伤后10～14d内)16例,男12例,女4例。方法:早期手术组于入院后72h内手术;择期手术组于入院后10～14d内手术。分别记录患者术前和术后24个月的Frankel分级和感觉、运动评分(依据美国脊髓损伤学会的标准)。主要观察指标:①两组患者术前、术后感觉评分及运动评分情况。②两组术前、术后Frankel分级结果。结果:①早期手术组感觉评分的改善程度(手术前后评分差值)明显高于择期手术组(42.6±20.2,19.2±19.1,P<0.01)。②早期手术组运动评分的改善程度(手术前后评分差值)明显高于择期手术组(39.7±17.8,17.3±18.6,P<0.01)。③早期手术组Frankel分级的改善程度明显优于择期手术组(P<0.01)。结论:急性颈椎颈髓损伤患者在72h内进行手术治疗,其神经功能恢复的结果优于10～14d内行手术者。因此,颈椎颈髓损伤后为了最大限度地促进神经功能的恢复,应早期进行外科干预。

BACKGROUND： Prognosis is determined by degrees of outside force and time of spinal cord compression after spinal cord injury. The former factor cannot be changed, but the latter one can be changed through relieving spinal cord compression as early as possible to promote nervous function recovery. OBJECTIVE： To compare the effect of surgical intervention time on nervous function recovery within 72 hours and 10 to 14 days after cervical spinal cord injury. DESIGN： Randomized controlled and before-after controlled study. SETTING： Department of Spine Surgery of the Second Hospital affiliated to Harbin Medical University. PARTICIPANTS： A total of 32 patients with cervical spinal cord injury were selected from the Department of Spine Surgery of the Second Hospital affiliated to Harbin Medical University from April 1998 to August 2001. All patients were divided into two groups according to randomly alternative criteria. There were 16 cases including 10 males and 6 females in early surgical group （within 72 hours） and there were also 16 cases including 12 males and 4 females in delayed surgical group （within 10-14 days）. METHODS： Patients in early surgical group were undertaken operation at 72 hours after hospitalization, and patients in delayed surgical group were at 10-14 days after hospitalization. Frankel grade, sensory and motor scores were recorded according to criteria set by American Spinal Injury Association before operation and within 24 months after operation. MAIN OUTCOME MEASURES： ① Sensory and motor scores before and after operation; ② Frankel grade before and after operation. RESULTS： ①Improved level of sensory score （difference before and after operation） was higher in early surgical group than that in delayed surgical group （42.6±20.2, 19.2±19.1, P 〈 0.01）.②Improved level of motor score （difference before and after operation） was higher in early surgical group than that in delayed surgical group （39.7±17.8, 17.3±18.6, P 〈 0.01）. ③ Improved level of Frankel grade in early surgical group was superior to that in delayed surgical group （P 〈 0.01）. CONCLUSION： Nervous function recovery of patients with acute cervical spinal cord injury who were suffered from operation within 72 hours is superior to that of those within 10 to 14 days. Therefore, surgical intervention should be undertaken as early as possible in order to promote nervous function recovery after cervical spinal cord injury.