扩大半椎板减压内固定治疗无骨折脱位型颈脊髓损伤

Treatment of cervical spinal cord injury without fracture and dislocation by expansive hemilaminectomy decompression and internal fixation

目的探讨后路扩大半椎板减压内固定术治疗无骨折脱位型颈髓损伤的疗效。方法回顾性分析2001年6月～2008年6月本院采用后路扩大半椎板减压植骨内固定术治疗的47例无骨折脱位型颈髓损伤患者的临床资料,通过随访比较术前、术后的JOA评分并结合影像学检查进行疗效评价。结果所有患者随访10～60个月,平均24个月,术后脊髓功能均有不同程度改善,JOA评分由术前平均7.6分上升至平均14.9分,植骨均获融合,无血管、神经及内固定相关并发症发生。结论颈椎后路扩大半椎板减压内固定术是治疗无骨折脱位型颈髓损伤的安全有效的方法,但需合理掌握手术适应证。

Objective To evaluate the clinical outcomes of cervical spinal cord injury without fracture and dislocation by expansive hemilaminectomy decompression and internal fixation. Methods Forty-seven cases with cervical spinal cord injury without fracture and dislocation underwent hemilaminectomy and internal fixation since June 2001 to June 2008, the JOA scores and image manifestations were reviewed to evaluate the clinical outcomes. Results All 47 patients were followed up for 10 to 60 months （average 24 months）, clinical symptoms were improved in all patients, the mean JOA score increased from 7.6 points preoperatively to 14.9 points postoperatively. All of the implanted bones were fused. There was neither cord or nerve root injury, nor vertebral artery injury. And there was no implant failure or other complications. Conclusion This technique is a safe and effective method in the treatment of cervical spinal cord injury without fracture and dislocation, while the patients must be selected by the operation indication strictly.