创伤致无骨折脱位颈髓损伤的手术时机探讨

Opportunity of surgical intervention for cervical spinal cord injury with no fracture and dislocation

目的探讨创伤致无骨折脱位颈髓损伤的外科手术时机。方法回顾性分析1999年-2007年诊治的59例创伤致无骨折脱位颈髓损伤患者的临床资料,根据治疗方式及接受手术时间的不同分成4组：非手术治疗组（12例）、1-7d手术组（15例）、8-14d手术组（19例）、14d以后手术组（13例）,比较4组间治疗前后的JOA评分改变。结果所有病例未发生血管、神经损伤等严重并发症,59例均获得24-30个月随访,脊髓神经功能按JOA评分比较,手术组高于非手术治疗组（P〈0.05）,8-14d手术组高于1-7d手术组（P〈0.05）,1-7d手术组高于14d以后手术组（P〈0.05）。结论无骨折脱位颈脊髓损伤手术治疗明显优于非手术治疗。手术时机对脊髓功能恢复有重要影响,最好在伤后8-14d（平均10.2d）内进行。

Objective To explore the opportunity of surgical intervention for cervical spinal cord injury with no fracture and dislocation.Methods The clinical data of 59 patients with cervical spinal cord injury complicated with no fracture and dislocation from 1999 to 2007 were retrospectively analyzed.According to the ways of treatment and the time before operation,4 groups were created： non-operation,operation at 1st-7th day,operation at 8th-14th day,operation after 14th day.Pre-operative and post-operative JOA scores were compared among the 4 groups.Results No severe vascular and neurological complications occurred.Fifty-nine cases were followed up for 24-30 months.According to JOA scores,The operation patients had significantly better outcome in neural function than the non-operation patients（P〈0.05）.Patients receiving operation at 8th-14th day had significantly better outcome in neural function than those receiving operation at 1st-7th day（P〈0.05）,and those receiving operation at 1st-7th day had better outcome in neural function than those receiving operation after 14th day（P〈0.05）.Conclusion The effect of operative treatment is significantly superior to the conservative treatment.The timing of surgery has important effect on the late recovery of spinal cord.The best timing of surgery should be 8th-14th day（average 10.2 days） after the injury.