无骨折脱位颈外伤脊髓综合征的临床特点与治疗

Clinical Features and Treatment of Spinal Cord Injury Syndromes without radiographic spinal fracture-dislocation

目的探讨无骨折脱位颈脊髓损伤(SCIWORFD)的临床特点与合理治疗方案。方法总结2002年1月～2008年3月收治无骨折脱位颈脊髓损伤的临床资料,中央脊髓综合征(CCS)42例,前脊髓综合征(ACS)12例,脊髓半切综合征(BSS)1例。依据JOA评分,对各治疗组进行治疗前后疗效评价。结果各组治疗前后P<0.05,差异有统计学意义。优良率:CCS A组95.6%,CCS B组84.2%,ACS组75%。BBS 1例治疗改善率87.5%。结论无骨折脱位颈脊髓损伤大多表现为CCS,其次为ACS,BSS少见;CCS根据颈椎稳定性是否存在椎管内压迫物制定治疗方案、ACS采用颈前路减压植骨钢板内固定治疗,BSS不存在椎管内压迫物者保守治疗,可获得满意疗效。

[ Objective ] To explore the clinical features and effective treatment of spinal cord injury without radiographic spinal fracture-dislocation （SCIWORFD）. [ Methods ] To analyze retrospectively the cases of SCIWORFD in Jan, 2002-Mar, 2008, including central cord syndrome （CCS） 42 patients, anterior cord syndrome （ACS） 12 patients, Brown-Sequard syndrome （BSS） 1 patients, which were treated by expectant treatment, or operative treatment; and the curative effect was evaluated by JOA evaluation. [ Results ] There were significant differences between pretreatment and post-treatment about each group （P 〈0.05）. The rate of excellent and good： CCS A group 95.6%, CCS B group 84.2%, ACS group 75%. The improvement rate of 1 case BBS was 87.5%. [Conclusion] To the cases with SCIWORFD, most of them were CCS, some of them were ACS, and the cases with BSS were few. It can get reliable curative effect to choice expectant treatment or operation to CCS according to whether there was oppressive body in canal or not, give anterior decompression with bone grafting and plate fixation to ACS, give expectant treatment to BBS without oppressive body in canal.