颈椎过伸性脊髓损伤的手术干预时机对手术疗效和手功能恢复的影响

The effect of timing of surgical intervention on functional recovery of the hand and treatment of hyperextension injury to the cervical spinal cord

目的 探讨颈椎过伸性脊髓损伤的手术干预时机对手术疗效及手功能恢复的影响.方法 2005年2月至2009年8月共收治34例颈椎过伸性损伤患者,根据接受手术的时间分为3组：1～6 d手术组（17例）、6～14 d手术组（10例）、14 d以后手术组（7例）,比较3组手术前、后美国脊髓损伤协会（ASIA）运动评分改变,并分析手术前、后手内在肌功能改善情况.结果 34例患者术后获12～40个月（平均18个月）随访.ASAI运动评分：术后1个月和末次随防总的功能改善率1～6 d手术组优于6～14 d手术组和14 d以后手术组,差异有统计学意义（P＜0.05）,6～14 d手术组与14 d以后手术组无明显差异.手内在肌功能改善率1个月内3组间差异无统计学意义（P=0.101）;末次随访时1～6 d手术组优于6～14 d手术组及14 d以后手术组,差异有统计学意义（P＜0.05）,6～14 d手术组与14 d以后手术组无明显差异.结论 颈椎过伸性损伤应该在伤后6 d内手术,尽早减压是最大限度恢复神经功能、减少相关并发症的关键.手术干预时机对手运动神经功能短期恢复无明显影响,但对远期恢复有明显影响.

Objective To determine the correlations between the time of surgical intervention, effect of surgery and functional recovery of the hand in the treatment of hyperextension injury to the cervical spinal cord. Methods We treated 34 cases of cervical hyperextension injury from February 2005 to August 2009. According to the time of surgical intervention, they were classified into 3 groups. In group A, 17 cases received operation within 6 days, in group B 10 cases had operation from 6 to 14 days, and in group C, 7 cases had operation after 14 days. The 3 groups were compared respectively in terms of their preoperative and postoperative American Spinal Injury Association （ASIA） motor scores and their functional recovery of the hands＇ intrinsic muscle. Results They were followed up for 12 to 40 months. By ASIA scores for spinal nerve function, group A was significantly better than groups B （ P =0. 025） and C （ P =0. 042） in one month and at the last follow-up after operation but there was no significant difference between group B and C （ P =0. 849） . In strength of the intrinsic muscle in one month after operation, there was no significant difference （P = 0. 101 ） between the 3 groups. In the neural function at the last follow-up, group A was significantly better than group B （ P = 0. 034） and group C （ P = 0. 006）, but there was no significant difference （ P =0. 217） between groups B and C, Conclusions Patients with hyperextension injury to the cervical spinal cord should be operated on within 6 days after injury. Early operative decompression is the key to nerve functional recovery and reduction of associated complications. The short-term functional recovery of the hand intrinsic muscle may have no obvious relation to the time of surgical intervention but the long-term recovery may be obviously related to the operative time.