急诊手术治疗腰椎创伤后不完全性马尾综合征的疗效观察

Outcome of urgent surgery for incomplete cauda equina syndrome caused by lumbar spine trauma

目的 比较急诊手术和择期手术治疗腰椎（脊柱）创伤后不完全性马尾综合征的临床疗效. 方法 2004-04～2009-05对61例腰椎创伤后不完全性马尾神经损伤患者进行手术治疗,根据随机配伍原则分为急诊手术组（研究组,n=30）和择期手术组（对照组,n=31）.研究组在伤后12 h内手术.采用美国脊髓损伤协会（ASIA）神经功能分级、Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分量表（VAS）和尿失禁调查问卷简表（ICIQ-SF）比较两组患者术后及随访期内（10～25个月）神经功能恢复情况.结果 研究组和对照组术后神经功能改善率分别为43.3%和16.1%（χ2=5.424,P=0.020）,末次随访时神经功能改善率分别为76.7%和58.1%,但组间比较差异无统计学意义（χ2=2.394,P=0.122）.研究组和对照组在末次随访时ODI评分分别为16.5分和31.0分（Z=-2.165,P=0.030）,ICIQ-SF评分分别为3分和9分（Z=-2.776,P=0.005）,VAS评分比较差异无统计学意义（P=0.070）.结论 腰椎创伤后不完全性马尾综合征患者在伤后12 h内急诊手术解除神经压迫可以早期恢复神经功能,提高生活质量.

Objective To estimate the outcome of urgent surgery for incomplete cauda equina syndrome caused by lumbar spine trauma. Methods Between April 2004 and May 2009, a total of 61 patients with incomplete cauda equina syndrome caused by lumbar spine trauma who underwent lumbar decompression surgery were divided into those who underwent surgery within 12 hours after trauma （urgent surgery group, n = 30） and those who underwent elective surgery over 12 hours after injury （ elective surgery group or control group, n = 31 ） according to randomized block design. American Spinal Injury Association （ASIA） Impairment Scale, Oswestry Disability Index （ODI）, Visual Analogue Pain Scale （ VAS）, International Consultation on Incontinence Questionnaire - short form （ ICIQ - SF） were used to evaluate nerve function after surgery and during follow up. Results Improvement rate of nerve function after surgery in urgent surgery group and control group were 43.3% and 16. 1%, respectively （X2 = 5.424, P = 0. 020）. The rate at the ultimate follow＇up in the urgent surgery group （76. 7% ） was higher than that in control group （58. 1% ）, but there was no statistically significant difference between the two groups （x^2 = 2. 394, P = 0. 122）. In the last follow up period, ODI in the two groups were 16. 5 and 31.0, respectively （Z = -2. 165, P =0. 030）, and ICIQ - SF were 3 and 9, respectively （ Z = - 2. 776, P = 0. 005 ）, but no statistically significant difference was found in the VAS between groups （ P = 0. 070）. Conclusion Emergency surgery to decompress the nerve as early as possible for incomplete cauda equina syndrome caused by lumbar spine trauma may early improve nerve function and quality of life.