无骨折脱位型颈髓损伤的诊治

Diagnosis and therapy on spinal cord injury without fracture dislocation

目的探讨无骨折脱位型颈髓损伤的诊断及治疗方法。方法35例无骨折脱位型颈髓损伤患者分别应用保守治疗及手术治疗，其中男24例，女11例，平均48岁。结果本组患者保守治疗10例、手术治疗25例，35例患者均得到随访，平均随访18个月（8～36个月）。以日本骨科学会JOA评分标准评估术后改善程度，保守治疗组疗效为优或良3例，有效率为30％；手术组疗效为优或良18例，有效率为72％；两组疗效比较差异有显著性（P〈0．05）。结论颈髓MRI检查对无骨折脱位型颈髓损伤诊断及治疗有较高价值；对存在颈髓受压的无骨折脱位型颈髓损伤应早期手术减压治疗，应根据颈髓受压的来源决定手术方式。

Objective To explore the diagnosis and treatment for spinal cord injury without fracture dislocation. Methods 35 cases of patients with spinal cord injury without fracture dislocation were applied with conservative treatment and surgical treatment respectively, including 24 male patients and 11 female patients, with an average age of 48. Results Patients consisted of 10 cases of conservative treatment and 25 cases of surgical treatment. All the 35 cases had received following-up investigation lasting for 18（8-36）months in average. The JOA marking criterion was used for rating operation improvement. In the conservative treatment, there were 3 cases having excellent or good therapeutic effect with an effective rate of 30%, while there were 18 cases having excellent or good therapeutic effect in the surgical group with the effective rate of 72%. Conclusion MRI inspection in cervical spinal cord is favorable for the diagnosis and treatment for spinal cord injury without fracture dislocation; early phase surgery decompression operation should be carried out but compressed cervical spinal cord and the surgical approach should be delermined according to the source of cervical spinal cord compression.