无骨折脱位型颈脊髓损伤早期手术治疗的疗效观察

Observation on therapeutic effect of early operation techniques for cervical spinal cord injury without fracture or dislocation

目的 探讨无骨折脱位型颈脊髓损伤（cervical spinal cord injury without fracture and dislocation,CSCIWOFD）早期手术治疗的术式选择与神经功能恢复的关系.方法 回顾性分析30例平均3天内行手术治疗的CSCIWOFD患者的临床资料,同一位手术者根据病情及影像学资料的不同分别行颈前路减压植骨内固定术（A组,n=15）,或颈后路全椎板切除钉棒内固定术（B组,n=9）,或颈前后路联合手术（C组,n=6）,并收集所有患者术前及术后平均10个月随访的日本矫形外科协会 （Japan Orthopedic Association,JOA）评分数据,进行组内及组间比较.结果 各组组内术后平均10个月随访JOA评分较入院时明显改善（P〈0.05）;3组组间JOA评分改善率比较差异无统计学意义（P〉0.05）.结论 对于CSCIWOFD需要早期手术治疗的患者,术者根据病情及影像学表现采取合理的手术方法,其神经功能的恢复会达到较满意的效果.

Objective To investigate the relationship between neurological recovery and the selection of early opera- tion techniques for cervical spinal cord injury without fracture and disloeation （CSCIWOFD）. Methods 30 cases with CSCIWOFD were retrospectively reviewed. All patients were treated by the same doctor who had taken the operation ac- cording to the clinical situation and radiological information, and the operation were taken within 3 days after injury. 15 cases （group A） were treated by anterior spinal cord decompression and reconstruction. 9 cases （group B） were treated by posterior spinal cord decompression plus reconstruction. 6 cases （ group C） were treated by anterior combined posterior operations. The Japanese Orthopaedic Association score （JOA score） was evaluated before operation and at an average of 10 months follow - up after operation. Results The JOA scores in all the groups were significantly improved at an ever- age of 10 months follow - up after operation compared with the JOA scores before operation （ P 〈 0.05 ）. No siginificant differences were observed for the rate of improvement in JOA scores among the 3 groups （ P 〉 0.05 ）. Conclusion If pa- tients with CSCIWOFD need early operation, proper operation techniques based on the clinical status and radiological in- formation can achieve efficient clinical outcome.