严重慢性机械压迫性脊髓损伤的手术疗效分析

Outcome after Operation in Patients with of Severe Chronic Spinal Cord Injury Caused by Mechanical Compression

目的:评价严重慢性机械压迫性脊髓损伤的手术疗效。方法:回顾性分析手术治疗的28例严重慢性脊髓损伤患者的临床资料,根据术前及术后随访24月时JOA评分的变化进行疗效评价。结果:脊髓型颈椎病7例,颈椎后纵韧带钙化6例,寰枢椎脱位1例,胸椎黄韧带钙化7例,胸椎黄韧带钙化并后纵韧带钙化4例,胸腰椎创伤后后凸畸形3例;均根据损伤类型进行相应手术治疗;随访结果显示术后24月时患者的JOA评分较术前均增加(P<0.05),疗效评价"差"2例,"一般"5例,"好"21例。结论:对于大部分严重慢性机械压迫性脊髓损伤患者手术治疗可取得良好疗效,手术方式是影响部分患者疗效的重要因素。

Objective： To assess the surgical outcome of severe chronic spinal cord injury caused by mechanical compression. Methods： The clinical data of 28 patients who received surgery to treat severe chronic spinal cord injury caused by mechanical compression were analyzed retrospectively. Results： The diagnosis of 28 patients includes cervical spondylotic myelopathy （7 cases）, cervical ossification of the posterior longitudinal ligament （OPLL） （6 cases）, thoracic ossification of ligamentum flavum （OLF, 7 cases）, thoracic OPLL coexisting OLF （4 cases）, thoracic myelopathy secondary to thoracolumbar fracture （3 cases） and atlantoaxial dislocation （1 case）. The JOA scores of both the cervical and thoracic myelopathy patients were increased gradually at 3, 6 and 12 months follow-up postoperatively. The outcome was found ＂bad＂ in 2 patients, ＂fair＂ in 5 patients and ＂good＂ in 21 patients. Conclusion： Surgical treatment is effective in most of the severe chronic compressive spinal cord injury patients. Surgical approach is critical to avoid postoperative neurological deterioration in some patients.