无放射影像异常颈脊髓损伤的治疗与预后

Management and Prognosis of Cervical Spinal Cord Injury without Radiographic Abnormality (SCIWORA)

目的：观察颈椎无放射影像异常脊髓损伤（ＳＣＩＷＯＲＡ）的手术治疗效果。背景：过去对颈椎ＳＣＩＷＯＲＡ，通常行保守治疗，多数系中央脊髓损伤，手内在肌恢复较差。为了改善其预后，乃行手术治疗，本组１０例，８例过伸损伤，２例屈曲损伤，７例中央脊髓损伤，２例前脊髓损伤，１例完全脊髓损伤。方法：（１）Ｘ线平片测量颈椎椎管矢径，８例狭窄。（２）ＭＲＩ：１０例均见椎间盘突出，在中央脊髓损伤，７例为单节段脊髓信号异常（Ｔ２加权成像），８例有椎管狭窄，脊髓前、后受压。（３）治疗：３例于伤后２６小时内行扩大半椎板减压，２例于保守９～１５天间行扩大半椎板减压。１例椎间盘突出行前减压。４例晚期病例，３例行扩大半椎板减压，１例全椎板减压。结果：平均随访１２个月，按Ｆｒａｎｋｅｌ分级，４例恢复至Ｅ，３例至Ｄ，１例仍为Ｄ。在１５天之内减压之５例，手内在肌与其他肌肉均恢复，而晚期减压病例，手内在肌无恢复。结论：（１）颈椎ＳＣＩＷＯＲＡ，在Ｘ线平片及ＭＲＩ多有椎管狭窄且中央脊髓损伤占大多数。（２）伤后２周内早期减压是治疗的首选，扩大的半椎板切除适于椎管狭窄病例，而前减压则适于椎间盘突出病例。（３）ＭＲＩ表现有预后意义，单节段信号改变者预后?

Object: To observe the result of operative treatment of cervical spinal cord injury without radiographic abnormality (SCIWORA). Back ground: Most of the cases with SCIWORA were central cord syndrom and the intrinsic muscles of the hand were usually incompletely recoverd by the conservative treatment. For this reason, the operative decompression was performed to improve the prognosis. There were 8 extension and 2 flexion injuries resulting in 7 central cord syndrom,2 anterior cord syndrom and 1 complete cord injury. Methods: Preoperative examination showed that 8 cases with cervical stenosis on the X_ray film. On T 2 weighted image, 10 cases with disc protrusion 7 displayed abnormal signal in one level segment. Enlarged hemilaminectomy was performed 26 hours after injury in 3 cases and 9 to 15 days in 2 cases. Anterior decompression was carried out in one case with disc herniation. Delayed hemilaminectomy was performed in 3 and delayed total laminectomy in one. Results: There were 4 cases recovered to E, 3 to D and one remained in D with an average of 12 months follow_up according to Frankel grading.Recovery of intrincic muscle occured in 5 cases underwent early decompression. Conclusion: Most of SCIWORA are central cord lesion associated with cervical stenosis.Early decompression is the treatment of choice.Enlarged hemilaminectomy is indicated to the case with cervical stenosis and anterior decompression indicated to a disc protrusion. In case of abnormal signal within one segment on MRI, the prognosis usually is good.