椎管储备间隙减少的过伸性颈髓损伤的颈前路治疗

Anterior surgery for hyperextension injury of the cervical spinal cord in the decreased storing space of spinal canal

目的探讨椎管储备间隙减少的颈髓过伸性损伤的受伤特征和前路手术治疗效果。方法回顾性分析大连医科大学附属二院骨外科于2004年3月～2009年3月收治的52例患者的临床资料,所有病例均经MRI提示为原有椎管储备间隙减少,其中所有病例均有颈间盘突出,27例患者存在椎管狭窄,根据对25例对于致压物主要在间盘水平的病例,将病变间隙突出间盘切除,自体髂骨植骨块植骨或带有自体骨颗粒的钛网或椎间融合器植骨融合钢板内固定术;对于27例存在明显椎管狭窄者,单纯间盘切除不能彻底减压,行椎体次全切除钛笼植骨融合钢板内固定术。术后对临床结果进行JOA评分;观察并记录患者的神经功能恢复、临床症状的改善及颈椎融合情况,比较手术前、术后随访时JOA评分,评价临床治疗效果。结果 49例患者获得随访,3例外地患者失访,时间6～24个月,平均随访时间是10个月。按JOA评分术前患者JOA评分为(8.55±1.52)分,半年随访时JOA评分为(12.87±1.68)分,采用配对t检验对术前、术后随访时JOA评分进行统计学分析,有显著性差异(P<0.001,α=0.05),其中将手术改善率为(56.37±5.58)%。术后随访平均5个月X线片示椎体间骨性融合。结论对于椎管储备间隙减少基础上造成的颈椎过伸性损伤的患者,颈前路减压植骨加带锁钢板内固定手术是一种较好的选择。

Objective To study the injury character of hyperextension injuries of cervical spinal cord and treatment effect of anterior surgery. Methods From March 2004 to March 2009,52 cases with hypcrextension injuries of cervical spinal cord were treated in the Second Affiliated Hospital of Dalian Medical University. All the cases were with the decreased storing space of spinal canal in MRI, in which all the cases had cervical spinal cord herniation, including cervical spinal stenosis in 27 cases. 25 cases with pressure in the disc level were performed anterior cervical discectomy and with iliac bony fusion or tita- nium net bony fusion or cage fusion and internal fixation. 27 patients with cervical spinal stenosis were treated with anterior cervical subtotal eorpectomy using titanium mesh and locking plate. To follow up all the postoperative eases, neural function and clinical symptoms imporoved and bony fusion was recorded. According to JOA score, preoperative score and postoperative follow up score were compared, improvement rates were caleulated respectively. Results 49 eases were followed up after op- eration,3 cases were lost. Time of follow - up ranged from 6 - 24 months （the average was 10 months）. The JOA of before op- eration was （ 8.55 ＋ 1.52 ） , the JOA in a half year after operation was （ 12. 87 _＋ 1.68 ） , t test was used to compare preoperative and follow up JOA scores. The statistical results were significantly different （ P 〈 0. 001 , e~ = 0.05 ）. The improvement rate of postoperative was （ 56. 37 ~ 5.58 ） %. The bony fusion occurred in five months by x - ray inspection. Conclusion For hyper- extension injury of the cervical spinal cord in the decreased storing space of spinal canal patients, anterior cervical decompres- sion and bone graft and internal fixation is a good choice.