老年性无骨折脱位颈椎脊髓损伤的治疗

Treatment for cervical spinal cord injury without fracture and dislocation in elderly patients

目的:探讨手术和非手术治疗方法治疗老年性多节段无骨折脱位型颈脊髓损伤的疗效差别以及手术时机的选择。方法:回顾性分析38例老年性无骨折脱位型颈脊髓损伤患者的临床资料,其中18例行非手术治疗,20例行手术治疗,经随访比较治疗前后JOA评分的变化。结果:两组治疗前后的JOA评分改善率间有差别(F=64.98,P<0.001),手术组相对保守治疗组JOA评分改善率高(F=48.68,P<0.001);保守治疗组治疗后3个月与治疗后12个月的JOA评分改变不大,而手术治疗组JOA评分持续改善。保守治疗病例脊髓功能恢复程度低,而手术治疗病例脊髓功能恢复程度较高。结论:无骨折脱位型颈脊髓损伤手术治疗效果明显优于非手术治疗,伤后至手术时间越长,效果越差。

Objective： To compare the outcomes of operative or conservative treatment for multiple- levels cervical spinal cord injury without fracture and dislocation in patients more than 70 years of age. Methods： 38 cases who were treated from January 1998 to June 2004 were analyzed.20 patients received operative and 18 underwent conservative treatment. Medical records and radiologic features （radiographs, CT and MRI） of patients were reviews to evaluate cervical stability, outcomes of surgery, post-operative complication and neurologic deficits before and after surgery using the Japanese Orthopaedic Association scoring system （JOA score）. Results： The improvement rate of the JOA scores were significantdifference between the operative and conservative group.（ F=64.98, P〈0.001）;The JOA scores of operative group were improved much than the conservative group （F=48.68 ,P〈0.001 ）. The JOA scores of conservative group at the 6th month, the 12th month were not statistical different. However, those of operative group were improved persistently as time goes by. Conclusion： Surgical treatment has a better clinical curative effect for the patients of multiple-levels cervical spinal cord injury without fracture or dislocation. Once have final diagnosed, early surgical treatment is necessary.