34例成人无骨折脱位型颈髓损伤的临床分析

Clinical research and analysis on spinal cord injury without fracture and dislocation

目的探讨无骨折脱位型颈髓损伤患者的损伤机制,比较手术与非手术治疗效果,了解患者椎管前后径与损伤程度的相关性。方法回顾性分析34例无骨折脱位型颈髓损伤患者,按后伸位、前屈位、其他体位和体位不明统计患者的损伤机制。判断损伤体位基于患者对受伤过程的回忆和体检时患者头面部皮肤肿胀、擦伤等方面。根据ASIA脊髓损伤评分标准,分别于治疗前和治疗后3、6、9、12个月评定患者的神经功能,比较手术组患者(n=22)与非手术组患者(n=12)治疗后不同时间与治疗前神经功能评分变化情况;测量患者损伤部位的椎管前后径,将之与患者的神经功能评分进行相关性分析。结果本组病例中,过伸损伤23例,过屈损伤4例,其他损伤1例,体位不明6例。治疗后3个月、6个月、9个月和12个月ASIA运动评分增加幅度分别是:手术组为7.16±0.81、8.33±0.69、13.51±1.03、16.82±1.21;非手术组为5.22±0.64、6.09±0.55、8.66±0.78、11.57±0.96。治疗后3个月、6个月、9个月和12个月ASIA感觉评分增加幅度分别是:手术组为14.31±1.37、22.37±2.30、31.87±2.86、37.66±3.39;非手术组为9.53±1.09、15.72±1.23、18.48±1.57,22.84±2.83。经t检验,在各个时相点2组均有统计学意义(P<0.05)。患者椎管前后径与患者的神经功能评分之间无明显相关性,但其平均椎管前后径小于9mm,且大多数患者有后纵韧带钙化、椎间盘突出等病变。结论成人无骨折脱位型颈髓损伤患者多数伴有椎管狭窄,其受伤机制多为过伸损伤,手术治疗效果明显优于非手术治疗。

Objective To study the possible mechanism of cervical spinal cord injury without fracture dislocation and the relationship between the canal anteroposterior diameter and the spinal cord function in adult,and compare the difference of function regain level of spinal cord after operative or non-operative treatments of these patients.Methods 34 cases with cervical spinal cord injury without fracture and dislocation were retrospectively analyzed and divided into operative treatment group（n = 22） and nonoperative treatment group（n = 12）.ASIA scores at injury and during follow-up（3,6,9,12months） were recorded to make comparison between operative treatment group and non-operative treatment group before and after treatment.According to the injury position,mechanisms were recorded as post-extending,anteflexion,other position and unidentified position.Correlation function between the canal anteroposterior diameter and the spinal cord ASIA scores were investigated.Results 23 out of 34 patients were injured in post-extend position.3,6,9 and 12 months after treatment,regained motive ASIA scores of operative group were 7.16±0.81,8.33±0.69,13.51±1.03,16.82±1.21 respectively,and the scores of non-operative group were 5.22±0.64,6.09±0.55,8.66±0.78,11.57±0.96.Regained sensitive ASIA scores of operative group were 14.31±1.37,22.37±2.30,31.87±2.86,37.66±3.39 respectively,and the scores of non-operative group were 9.53±1.09,15.72±1.23,18.48±1.57,22.84±2.83.There was a significant difference between both groups through t test（P0.05）.Though there was not significant relationship between canal anteroposterior diameter and the spinal cord ASIA scores,most of these patients were suffered with spinal stenosis.The average diameter of these patients was less than 9mm.Conclusions In adult patients,spinal cord injury without fracture and dislocation may based on cervical spinal stenosis,and the injury in post-extend position may be more dangerous.For the cervical spinal cord injury without fracture and dislocation in adult,the operative treatment is superior to the non-operative treatment.Once the diagnosis is verified,the operative treatment should be carried out as early as possible.