无骨折脱位型中央管综合征的特点及手术治疗效果

Features and surgical outcome of central cord syndrome without fracture or dislocation

目的分析无骨折脱位型中央管综合征的特点并评估手术治疗的有效性。方法手术治疗无骨折脱位型中央管综合征患者2l例，常规行x线片、cT和MRI检查。采用美国脊柱损伤协会（American Spinal Injury Association，ASIA）标准评估神经功能障碍及其改善情况。对所有患者的影像学、临床表现特点进行分析，并对手术前、后ASIA分级及评分进行统计学分析。结果21例患者颈脊髓均存在局部受压，致压因素为颈椎间盘突出18例，其中5例伴有黄韧带肥厚皱褶，2例发育性颈椎管狭窄，1例后纵韧带骨化。神经功能障碍表现为上肢型15例，四肢型6例。平均随访13．5个月。术前ASIA评级C级9例，D级12例，末次随访时C级1例，D级6例，E级14例。ASIA评分运动功能障碍改善率为（84．3±12．5）％，感觉功能障碍改善率为（62．7±14．6）％。运动和感觉功能ASIA评分在手术前、后比较差异均有统计学意义（P〈0．05）。结论颈椎问盘突出是无骨折脱位型中央管综合征的主要脊髓致压因素，神经功能障碍以上肢型多见，手术治疗是解除颈脊髓受压、促进神经功能恢复的有效方法。

Objective To investigate the characteristics of central cord syndrome without fracture or dislocation and assess the effect of surgical management. Methods Twenty-one cases of central cord syndrome without fracture or dislocation were diagnosed with X-ray radiography, CT and MRI and treated surgically. Spinal cord dysfunction and its recovery rate were evaluated using American Spinal Injury As- sociation （ASIA） system. Radiological and clinical evaluation was performed for all cases. Pre- and post- operative ASIA scale and score were statistically analyzed. Results All cases sustained cervical spinal cord compression resulting from cervical disc herniation in 18 cases, of which five were accompanied by ligamentum flavum hypertrophy and reductus, developmental cervical spinal canal stenosis in two cases and posterior longitudinal ligament ossification in one case. Neurological dysfunction involved in the upper extremity in 15 cases and upper and lower extremity in six cases. Mean period of follow-up was 13.5 months. ASIA scale was improved from C （ n = 9） and D （ n = 12） before operation to C （n = 1 ）, D （ n = 6） and E （n = 14） in the last follow-up. ASIA score of motor and sensory dysfunction revealed a （84.3 ± 12.5 ） % and （62.7 ± 14.6） % improvements, with significant difference as compared with the preopera- tive one （ P 〈 0. 05 ）. Conclusions Cervical disc herniation is the major factor of spinal cord compres- sion in central cord syndrome without fracture and dislocation. Neurological dysfunction occurs mostly in the upper extremity. Surgery is an effective method to release spinal cord compression and restore neuro- logical function.