无骨折脱位型急性外伤性颈髓中央综合征的治疗

Clinical treatment of acute traumatic central cervical spinal cord syndrome without fracture and dislocation

目的:分析无骨折脱位型急性外伤性颈髓中央综合征的临床治疗疗效,探讨其治疗方法。方法回顾性分析47例无骨折脱位型急性外伤性颈髓中央综合征患者的临床资料,男44例,女3例;年龄46～73岁,平均56.2岁。脊髓神经功能Frankel分级,B级30例,C级14例,D级3例。对于脊髓有明确的外在致压因素或损伤节段不稳的5例采用手术治疗,其中前路手术3例,后路手术2例,非手术治疗42例。对其致伤原因、致伤机制、影像学表现、神经功能损伤程度、治疗方法及临床疗效进行分析。结果:6例失访,非手术治疗死亡2例。39例术后随访3～84个月,平均12个月。治疗后3个月内,非手术7例出现并发症,但两组患者后期均有不同程度的肢体神经痛。多数病例遗留手内在肌功能不同程度的损害。结论:根据病情及影像学资料灵活选择治疗方案,保守和手术均可取得良好的治疗结果。

Objective：To analyze clinical characteristics and therapeutic efficacy of acute traumatic central cervical spinal-cord syndrome without fracture and dislocation, and to investigate its treatment methods. Methods：Clinical data of 47 cases with acute traumatic central cervical spinal-cord syndrome without fracture and dislocation were retrospectively analyzed. There were 3 female and 44 male,with a mean age of 56.2 years （ranging from 46 to 73 years）. According to Frankel classification ,30 cases were grade B, 14 cases were grade C and 3 cases were grade D. Forty-two cases were treated without operation, and 5 cases which had significant compression factors or segmental instability were treated with surgical treatment. Among them,3 cases were treated through anterior approach and 2 cases were treated through posterior approach. Causes of injuries, mechanisms of injuries,findings of imaging,functional impairment of nerve,methods of treatment,and therapeutic efficacy were analyzed. Results ： The average followed-up time was 12 months （ranging form 3 to 84 months）, 2 cases of non-operation were dead and 6 were loss. Three months after treatment, some complications occurrenced on 7 patients of non-operation. The majority bequeathed different degree impairment of intrinsic muscles of hands. Conclusion ： Reduction and fixation through the pedicle of fractured vertebra is an effective therapeutic options to treat the thoracolumbar burst fractures and desearved clinical study and expansion.