外伤性无骨折脱位颈髓损伤的手术治疗

Operative Treatment for Traumatic Cervical Spinal Cord Injury without Fracture Dislocation

目的：探讨手术治疗无骨折脱位颈脊髓损伤临床疗效。方法：手术治疗无骨折脱位颈脊髓损伤患者32例，其中前路15例，后路7例，前后路联合入路10例。结果：全组病例随访4～68个月，平均21个月。临床效果按JOA评分，平均改善率42．85％，优良率56．25％。颈前路融合术后出现相邻节段不稳2例，颈后路术后出现颈椎反曲畸形1例。结论：手术治疗无骨折脱位颈脊髓损伤，可充分、有效地减压，扩大椎管容积，恢复颈椎序列，重建颈椎结构稳定，避免脊髓的继发性损害。

Objective：To explore the effects of operative treatment for cervical spinal cord injury without fracture dislocation. Methods：Thirty two patients of cervical spinal cord injury without fracture dislocation underwent operation, including 15 cases via anterior approach, 7 via posterior approach and 10 via combination of both approaches. Results：All the patients had been followed up for 4 -68 months, average of 21 months. According to the JOA criteria, the improvement and excellent rates were 42.2% and 75% respectively. After the operations, cervical instability was found in two patients treated by cervical anterior approach, meanwhile, retroflexion of cervical spine occurred in one patient treated by cervical posterior approach. Conclusions ： The operative treatment for cervical spinal cord injury without fracture dislocation may completely and effectively decompress, expand the volume of vertebral canal, restore cervical sequence, reconstruct cervical stability and avoid secondary spinal injury.