外伤性颈椎间盘突出型脊髓损伤的手术治疗

Surgical treatment of traumatic cervical disc herniation with spinal cord injury

目的:评价外伤性颈椎间盘突出型脊髓损伤手术治疗的效果。方法:回顾分析48例外伤性颈椎间盘突出型脊髓损伤患者的临床资料,术前Frankel分级A级2例,B级16例,C级20例,D级10例;JOA评分平均5.5±3.5分。均采用颈椎前路椎间盘切除、椎体间植骨、钛板内固定术,依据术前、术后Frankel分级情况及JOA评分改善率评价治疗效果。结果:术后除1例Frankel分级B级患者无恢复外,其余患者恢复1～4个等级。随访4～36个月,平均18个月。术后2个月时JOA评分为12.2±3.2分,改善率为59.9%±17.8%;末次随访时JOA评分为14.4±3.6分,改善率为68.0%±17.0%。随访中未见内置物松动、脱落或断裂等并发症发生,固定节段均获得骨性融合。结论:应用颈椎前路椎间盘切除、椎体间植骨、钛板内固定术治疗外伤性颈椎间盘突出型脊髓损伤可获得较理想的脊髓功能恢复效果。

Objective：To evaluate the clinical results of surgical treatment for the traumatic cervical disc herniation with spinal cord injury.Method：The clinical data of 48 patients who suffered from traumatic cervical disc herniation with spinal cord injury were retrospectively reviewed.Neurologic status of all the patients was graded on Frankel scale,which included 2 cases grade A,16 cases grade B,20 cases grade C and 10 cases grade D.The preoperative average JOA score was 5.5±3.5.Surgical procedures included discectomy,strut bone grafting within vertebral bodies and internal fixation with titanium plate,The clinical outcomes were evaluated by the improvement of Frankel scale and the recovery ratio of JOA.Result：The follow-up period was from 4 to 36 months（averaged 18 months）,Only 1 patient with Frankel B had no improvement in neurological function,the others were found to get one to four scales＇ improvement.The recovery ratio of JOA was 59.9%± 17.8% in two months postoperatively and 68.0%±17.0% in the last follow-up.There was no hardware related complications such as loosening,un-tightening and brokenness.Bony fusion was found in all the target levels. Conclusion：Surgical procedures included discectomy,strnt bone grafting within vertebral bodies and internal fixation with titanium plate through anterior approach are reasonable choice for the patients of traumatic cervical disc herniation with spinal cord injury,which will be helpful to the recovery of spinal cord function.