基于改良Moore分类评分的下颈椎损伤诊治策略

Diagnosis and treatment strategy of lower cervical spine injuries based on modified Moore classification

目的探讨颈椎损伤程度评分系统的改良方案与下颈椎损伤的诊治策略。方法依据改良Moore分类评分系统，定性量化评分〈3分者，采用保守治疗；稳定性量化评分=3分，且不伴有脊髓或神经根受压损伤表现者，采用保守治疗；稳定性量化评分=3分，且伴有脊髓或神经根受压损伤表现者，建议手术治疗；稳定性量化评分≥4分，存在下颈椎不稳的可能，需要手术治疗。稳定性量化评分值越大，手术指征越明确；若伴有脊髓或神经根受压损伤表现者则有绝对手术指征。同时参考患者的其他因素，综合选择治疗方法。结果根据改良Moore分类系统的基本原则及参考患者及家属意见，手术治疗14例，保守治疗16例。完全性脊髓损伤（A级）患者中，2例手术治疗后无明显脊髓功能恢复迹象，但其神经根刺激症状基本消失；另1例未手术患者脊髓功能及神经根刺激症状基本无变化。不完全性脊髓损伤（B、C、D级）患者手术后脊髓功能均有一定程度恢复，美国脊髓损伤协会（ASIA）分级平均提高1．6级。未手术的不完全性脊髓损伤患者治疗后ASIA分级平均提高0．5级。不伴有脊髓神经损伤者手术后经影像学检查显示椎体问均已达到骨性融合，未见椎体问滑移或不稳定，均恢复了颈椎的正常序列和高度。结论改良颈椎损伤程度评分系统考虑了脊髓神经损伤情况，综合评判选择保守治疗或手术治疗，在一定程度上完善了颈椎损伤程度评分系统，具有一定的临床应用价值。

Objective To investigate the modification method of Cervical Spine Injury Severity Score System and discuss diagnosis and treatment strategy of lower cervical spine injuries. Methods Treatments of lower cervical spine injuries were selected according to the injury severity graded by the modified Moore＇ s classification system. Conservative therapy could be adopted for the patients with stabil- ity quantification rating 〈 3 points or for the those with stability quantification rating = 3 points but without spinal cord or nerve root compression. Surgical treatment was recommendable for the patients with stability quantification rating = 3 points and with spinal cord or nerve root compression. Surgical therapy could be required for the patients with stability quantification rating ≥4 points and with risk of lower cervical instability. The higher the stability quantification score implied the stronger the surgical indications. Lower cervical spine injury combined with spine cord or nerve root compression had absolute surgical indica- tions. At the same time, therapies were selected based on patients＇ other factors. Results Based on basic principles of the modified Moore＇ s classification system together with opinions of the patients and their relatives, 14 patients were managed with surgical treatment and 16 with conservative treatment. A- mong the patients with complete spinal cord injury （Grade A）, two patients treated surgically showed no obvious signs of spinal function recovery, but their nerve root irritation symptoms disappeared; the other one patient who needed surgery but received conservative treatment had no change of the spinal cord function and nerve root irritation. The patients with incomplete spinal cord injury （Grades B, C and D） treated surgically obtained certain degree of spine cord function recovery, with their American Spinal Injury Association （ASIA） score raised by 0. 5 grade on average. However, the patients who needed surgery but received conservative treatment gained average increase of ASIA score for 0.5 grade. Imaging examination showed that patients without combined spinal injuries obtained interbody fusion after surgery, with normal alignment and height of the cervical vertebra but without presence of vertebral shift or instability. Conclusions The modified Moore＇ s classification system takes patients＇ spinal injury condition and other factors into consideration in selection of conservative or surgical treatment, which improves the Cervical Spine Injury Severity Score System to some extent and has prospect of clinical application.