急诊颈椎后路探查减压术治疗病情不明的急性颈髓损伤

EMERGENCY CERVICAL POSTERIOR DECOMPRESSION FOR ACUTE CERVICAL SPINAL CORD LNJURY WITHOUT RADIOGRAPHIC EXAMINATION

目的：总结缺乏影像学检查情况下,急性颈髓损伤的诊断及急诊后路手术的治疗效果。方法：2001-01-2007-01间4例未能获得影像学检查的急性颈髓损伤病例。患者平均年龄33.7岁（19-49岁）,术前Frankel分级均为C级。所有患者均无其他疾病史,伤后一般情况稳定,查体、辅助检查未发现其他组织器官严重损伤。入院予甲强龙冲击治疗,颅骨牵引下行颈椎后路减压（和植骨内固定）术。手术时间为伤后13-21h,平均17.3h。术后留置气管插管,颈托或头颈胸石膏固定3月。结果：术后平均随访2年（6个月-4年）。无手术相关并发症。末次随访Frankel分级E级2例,D级2例。无颈椎不稳、后凸畸形发生。结论：在条件受限的情况下,应最大限度利用现有知识手段确诊急性颈髓损伤;急诊（小于24h）探查、减压手术,可使患者获得最大的神经功能恢复;颈椎后路手术较适宜病情不明时探查减压。

Objective：To assess the validity of emergency posterior decompression for acute cervical spinal cord injury（ACSCI）.Methods：Clincal data of 4 cases of ACSCI underewent posterior decompression during 2001-2007,were reviewed.Average age at operation were 33.7 years（19～49 years）.Frankel rank of all 4 cases was C.No major combined morbidity was discovered.Vital signs were stable in all 4 cases after injury.Sou-Medrol,axial traction and posterior decompression were applied.Average time from injury to operation was 17.3 hours（10-21 hours）.Extubation delays was used to reduce the risk of postoperative airway emergencies.Results：Postoperative Frankel ranks were E in 2 cases,and D in 2 cases with an average follow-up of 2 years（6 months to 2 years）.No surgical complications,or kyphosis was observed.Conclusion：ACSI could be properly diagnosed without radiographic examination.Posterior decompression may be safe and effective for unclear ACSI.Urgent operation within 24 hours may get better neurological results.