急性无骨折脱位型颈髓损伤的机制与治疗

Mechanism and treatment of acute traumatic cervical spinal cord injury without radiographic abnormality

目的 探讨急性创伤性无骨折脱位型颈脊髓损伤的机制及治疗方法。方法 对 2 7例无骨折脱位型颈脊髓损伤患者进行MRI检查 ;8例颈椎间盘突出对脊髓压迫明显者予以手术治疗 ,19例予以非手术治疗 ;分别于入院时及治疗后 6周对脊髓损伤程度按ASIA标准分级评定。结果 采用大剂量甲基强的松龙治疗 6例患者 ,6周后ASIA分级平均提高了 2个等级 ,神经功能改善较明显 ;颈椎间盘突出明显者早期手术治疗神经功能有一定改善 ,受伤 2周后手术治疗的患者 ,神经功能改善不明显。结论 无骨折脱位型颈脊髓损伤宜及早行MRI检查 ,以明确损伤的类型。无明显颈椎间盘突出者采用大剂量甲基强的松龙治疗具有较好的疗效。颈椎间盘突出对脊髓压迫明显者 ,晚期手术效果较差。

Objective To investigate the mechanism and treatment of acute traumatic cervical spinal cord injury without radiographic abnormality Methods MRI was performed in 27 cases of the disease, 8 cases of serious cervical disc herniation were treated with surgery;19 cases were treated nonsurgically. Neurologic functions were assessed by classification of ASIA on admission and 6 weeks after admission. Results 6 weeks later,the patients treated with methylprednisolone showed significant improvement in the neurologic function, an average classification of ASIA improved 2 grades. Early operative treatment might improve the neurologic functions of patients with serious cervical disc herniation. Conclusion Early MRI examination can be used to judge the injury type. And early treatment with high dose methylprednisolone in patients without cervical disc herniation can promote neurologic recovery; but for the patients with cervical disc herniation and obvious spinal cord compresion, the operation after 2 weeks shows poorer results.