无骨折脱位型颈中央脊髓损伤的治疗方法选择

Comparison of Operative and Conservative Therapy for Central Cervical Cord Injury without Fracture and Dislocation

目的:比较手术治疗与保守治疗无骨折脱位型颈中央脊髓损伤的疗效。方法:回顾分析2009年5月—2011年4月收治的35例外伤致颈中央脊髓损伤患者的临床资料,所有患者均经影像学方法证实无骨折或脱位。向患者详细解释手术治疗与非手术治疗的利弊,由患者自主选择治疗方法。其中22例患者选择手术治疗,13例选择保守治疗。随访15～26个月,平均19个月。采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)标准对脊髓运动功能进行评分并分级。对在院期间的ASIA评分进行直线回归和相关分析。计算治疗后12个月时恢复率,以此评价神经功能最终恢复情况。结果:2组患者在院期间ASIA评分均与时间呈正相关(手术治疗组r=0.974,P<0.01;保守治疗组r=0.856,P<0.01)。治疗后12个月随访时,手术治疗组患者获得至少1个级别的恢复。且手术治疗组恢复率[(75.3±18.6)%]高于保守治疗组[(53.3±15.2)%],差异有统计学意义(P<0.01)。结论:针对无骨折脱位型颈中央脊髓损伤,手术可明显提高神经功能的恢复率,应鼓励患者进行手术治疗。但伤后神经症状较轻(ASIA分级D级)且可以接受伤后神经功能的患者,可根据患者自身意愿选择保守治疗。

Objective： To evaluate the curative effects of operative and conservative therapy for central cervical cord injury without fracture and dislocation. Methods：From May 2009 to Apt 2011, 35 patients with central cervical cord injury, who had no cervical fracture and dislocation confirmed by radiological examination, were treated in Jinshan Hospital, Fudan University. A retro- spective study was performed on them. After discussion with patients, operative or conservative therapy was chosen by themselves. In 35 patients,22 patients had operation and 13 patients had conservative therapy. American Spinal Injury Association （ASIA） scores were recorded in the duration of hospitalization and followed up period （average 19 months, ranged from 15 to 26 months） to evaluate neuro- logical functions. Linear regression and correlation analysis were performed on ASIA scores recorded in hospital. At the 12th month, the recovery rate according to ASIA scores was used to evaluate the curative effect. Results： In the duration of hospitalization, ASIA scores were positively correlated with time（operative therapy group r = 0. 974, P〈0.01 ; conservative therapy group r = 0. 974, P〈 0. 01 ）. At the 12th month, the recovery rate of operative therapy group[（75.3 ± 18.6）%] was higher than that of conservative therapy group[（53.3 ± 15.2） % ], and 22 patients underwent operation had at least one level recoverment. Conclusions： Surgical operation can promote the recoverment of neurological functions in central cervical cord injury without fracture and dislocation. And those less severe patients （ASIA D） can be treated by conservative therapy.