无骨折脱位颈脊髓损伤的手术治疗

Surgical Treatment of Cervical Spinal Cord Injury without Fracture and Dislocation

目的探讨无骨折脱位型颈脊髓损伤的手术策略及治疗效果。方法根据影像学表现的不同,对26例无骨折脱位型颈脊髓损伤患者分别采用前路减压植骨融合内固定或后路单开门椎管扩大成形术,术前、术后采用Frankel分级和JOA17分法评价临床疗效。结果术后Frankel分级较术前明显改善。术前JOA评分为(5.3±2.5)分,术后随访末次JOA评分为(12.2±3.7)分,改善率为59%,有统计学意义(P<0.01)。结论对无骨折脱位型颈脊髓损伤,根据患者的不同特点,有针对性地选择手术方式,可以获得较好的临床结果。

Objective To evaluate the surgical treatment and its clinical outcomes of cervical spinal cord injury without fracture and dislocation. Methods Twenty-six cervical spinal cord injury patients without fracture and dislocation were performed posterior unilateral open-door laminoplasty or anterior spinal decompression and reconstruction individually. The selection of the surgical procedure was based on the appearance of radiography. Neurological function （Frankel grade and JOA scoring system） were evaluated before and after operation. Results No severe vascuneurological complication occurred. The Frankel grade was improved significantly after operation compared with that of before operation. The preopevative and postoperative JOA score were 5.3±2. 5 and 12. 2±3.7 respectively. The improvement rate was 59%. Conclusion Cervical spinal stenosis and cervical vertebra degenerative are the main pathological basis to cervical spinal cord injury without fracture and dislocation. Surgical treatment could achive an efficient outcome as long as the surgical procedure is selected correctly.