无骨折脱位型急性中央颈脊髓损伤的手术疗效分析

Appraise operative outcome for acute central cervical spinal cord injuries without fracture and dislocation

目的分析评价无骨折脱位型中央颈脊髓损伤的手术治疗效果。方法自2000年5月至2005年4月,手术治疗了52例无颈椎骨折脱位型中央颈脊髓损伤患者,均经术前影像学检查证实。所有患者都接受损伤段颈椎前路或后路减压、融合和内固定手术。住院期间每日进行症状和体征的观测,脊髓功能采用美国脊柱损伤协会(ASIA)标准进行评分,以线性回归分析方法评价手术对患者 ASIA 评分的影响。随访患者的最终脊髓功能恢复情况,时间从12～42个月,平均29个月。结果手术后 ASIA 恢复曲线明显较手术前抬升(P<0.01)。最终随访时所有患者的 ASIA 运动、针刺觉和轻触觉评分分别为(91±7),(107±6)和(107±6)分,均较术前有明显好转(P<0.01)。结论对损伤水平的脊柱充分减压和固定,可以给水肿的脊髓创造一个宽松和稳定的膨胀空间,加速脊髓功能的早期恢复,改善远期效果。

Objective To evaluate the injuries without fracture and dislocation. Methods surgical outcome for acute central cervical spinal cord A retrospective study was performed on 52 patients with acute central cervical cord injuries without fracture and dislocation from 2000 to 2005. All of patients underwent cervical anterior or posterior decompression, fusion and inter fixation. Spinal function was evaluated by ASIA （American Spinal Injury Association） guidelines. Pre- and post-operation ASIA scores were analyzed using liner correlation and regression. The neurological function was recorded during followedup. The average follow-up was 29 months （ range, 12 to 42 ）. Results After operation, the ASIA scores increased significantly （P 〈0. 01 ）. Finally, ASIA motor, pin pricking and light touching scores of the 41 patients were 91 ±7,107± 6 and 107 ± 6 respectively. Conelusion Decompression and inter fixation for injured segment can make a stable and capacious space for spinal cord, promoting early neurological recovery and long-term improvement.