脊髓锐器伤的临床疗效及预后观察

Clinical efficiency and prognosis of spinal cord injury caused by stab wound

目的探讨脊髓锐器伤的临床特点、治疗方案及脊髓功能的预后规律。方法定期随访、回顾性分析我科2003年4月～2006年6月收治的8例脊髓锐器伤的治疗、预后转归情况。8例中男性7例,女性1例;年龄10～32岁,平均21.4岁。均为不完全性脊髓损伤。入院后经甲泼尼龙、神经节苷脂、高压氧及脱水综合治疗,术前和术后进行神经功能评分和影像学观察。结果经过平均5.4个月治疗后,所有患者下肢感觉、运动功能恢复满意,生活完全自理。平均随访17个月,其中4例下肢感觉恢复正常,4例残留部分感觉障碍;5例运动完全正常,3例遗有部分运动功能障碍,轻度跛行。结论脊髓锐器伤多为不完全性脊髓横断伤,局部创伤小、出血少、离断的神经组织无明显移位、纤维瘢痕组织增生少,脊髓功能恢复好;脊髓功能的恢复在伤后3周左右达高峰;药物促进离断后无明显移位的轴突原位修复、残留神经纤维的代偿可能是脊髓锐器伤后脊髓神经功能恢复的主要机制。

Objective To investigate the clinical characteristics, treatment and prognosis of stab injury of spinal cord. Methods Retrospective study was performed on the clinical data of 8 stab-spinal-cord-injury （SCI） patients due to stab wound who were treated in our hospital from Apr. 2003 to Jun. 2006. All patients were underg- one the same treatments including methylprednisolone, ganglioside,high pressure oxygen, and anhydration. The A- SIA score and MRI observation were used for evaluating the prognosis of SCI. Results All patients gradually re- stored the self-dependence of living at 5.4 months after therapy. By the long-term follow-up,4 patients completely restored the sensation and locomotion,3 patients had incomplete recovery in sensation, and 1 patient had incomplete recovery in the locomotion. Conclusion According to the results above, better recovery, little loss-blood and slight injury are the clinical characteristics of spinal cord injury by stab wound. The recovery of spinal function is more noticeable at 3 weeks after injury. It is demonstrated that regeneration of the axon and compensation of residual nerve fibers after spinal cord injury might be the important mechanism for the recovery of sensation and locomotion.