无骨折脱位型颈髓损伤的治疗

Treatment of cervical spinal cord injury without fracture or dislocation

目的:探讨无骨折脱位型颈髓损伤(CSCIWFD)的治疗策略及临床疗效。方法:回顾性分析我科自2005年8月-2010年12月收治的51例CSCIWFD患者,根据日本骨科学会评分系统(JOA评分)分析CSCIW-FD患者治疗的短中期疗效。结果:全部患者随访6～60个月,平均24个月。43例患者采取手术治疗,JOA评分的平均改善率和优良率分别为(46.5±5.8)%和48.8%,均显著高于8例采取保守治疗患者JOA评分的平均改善率(25.6±3.1)%和优良率25.0%(P<0.01)。7d内手术的35例患者JOA评分的平均改善率和优良率分别为(50.6±3.6)%和54.3%,均明显高于7d后手术的8例患者JOA评分的平均改善率(37.5±2.9)%和优良率25.0%(P<0.01)。采用前路或后路手术的JOA评分平均改善率和优良率差异无统计学意义(P>0.05)。结论:根据CSCIWFD患者的影像学结果,选择合适的术式,尽早手术,可较好地改善颈脊髓功能,获得较满意的临床疗效。

Objective：To explore the treatment strategies and clinical outcomes of cervical spinal cord injury without fracture or dislocation（CSCIWFD）.Method：Fifty-one cases of CSCIWFD patients treated in our hospital from Aug 2005 to Dec 2010 were retrospectively analyzed.Their short and middle-term clinical outcomes were assessed according to JOA scale system.Result：All cases were followed up for 6 to 60 months（mean 24 months）.Forty-three cases were surgically treated and their average recovery rate of JOA scale was（46.5±5.8）%,and the percentage of receiving ＂excellent＂ or ＂good＂ ratings was 48.8%.The other 8 cases were conservatively treated and the same indexes were（25.6±3.1）% and 25.0% respectively,which were significantly lower than those from the surgical group（P0.01）.35 cases were surgically treated within 7 days since injury.Their average recovery rate of JOA scale was（50.6±3.6）% and the percentage of receiving ＂excellent＂ or ＂good＂ ratings was 54.3%.While the same indexes of the other 8 cases surgically treated after 7 day were（37.5±2.9）% and 25.0% respectively,which were significantly lower than those from the surgical group within 7 days after injury（P0.01）.But the average recovery rate of JOA scale and percentage of receiving ＂excellent＂ or ＂good＂ ratings had no significant differences between groups of anterior approach and posterior approach postoperative（P0.05）.Conclusion：Appropriate choices of operative method and time according to the radiographic results of the CSCIWFD patients will improve their spinal cord function and achieve relatively satisfactory clinical outcomes.