无骨折脱位型颈脊髓损伤的治疗

Treatment of cervical spinal cord injury without fracture or dislocation

目的探讨无骨折脱位型颈脊髓损伤的损伤机制及治疗。方法回顾性分析57例无骨折脱位型颈脊髓损伤患者的临床表现、影像学特点，根据损伤情况及影像学表现采取不同的手术治疗，比较手术前后的ASIA分级。结果本组患者单节段腹侧受压18例，采取颈椎前路减压、自体髂骨植骨、自锁定钢板固定术；多节段损伤（〉2节段）39例，采取颈椎后路椎板减压植骨融合内固定术。术后均获得随访，时间10—36个月（平均20个月）。术后ASIA分级情况：B级3例，C级4例，D级19例，E级31例。感觉和运动功能较术前均有明显改善。结论颈椎管存在原发性狭窄是无骨折脱位颈脊髓损伤的病理基础，轻微外力所致的过伸性损伤是其主要的受伤原因，甲泼尼松冲击治疗及尽早采取手术治疗可以取得良好的临床效果。

Objective To investigate the traumatic mechanism and the treatment of cervical spinal cord injury without fracture or dislocation. Method 57 patients were retrospectively analyzed on clinical manifestation and radiological feature. The varied methods were performed based on the trauma and radiography. ASIA grade was compared before and after operation. Results The average follow - up period was 20 months （ 10 - 36 months）. ASIA grade was B 3, C 4, D 19 and E 31 after operation. The sensorius and motive function were obviously improved after operation and the improvement was 98%. Conclusions Myelopathy in patients with genetic cervical spinal stenosis was pathological cause of cervical spinal cord injury without fracture or dislocation, good clinical outcomes can be acquired by large methylprednisolone and early surgical treatment.