无骨折脱位型颈脊髓损伤的预后分析

Prognostic analysis of cervical spinal cord injury without fracture or dislocation

目的 比较无骨折脱位型颈髓损伤（cervical spinal cord injury without fracture or dislocation,CSCIWFD）非手术治疗和手术治疗的疗效,分析其发生机制及其与预后的关系. 方法 回顾性分析1994年8月-2013年3月收治的CSCIWFD患者688例,对不同年龄段患者采用非手术治疗（非手术组,155例）和手术治疗（手术组,533例）后神经功能的恢复结果进行比较,分析不同年龄组患者、不同治疗方法与预后的相关性. 结果 随访3 ～ 36个月,平均17.9个月.两组患者神经功能改善程度按日本骨科学会（Japanese Orthopedic Association,JOA）评分：（1）40岁以上各年龄段患者神经功能改善率手术组均优于非手术组（P＜0.05）；（2）39岁以下年轻患者无论非手术或是手术治疗恢复均不理想,两组之间比较差异无统计学意义（P＞0.05）. 结论 不同年龄CSCIWFD患者损伤机制不同,脊髓损伤程度及预后也不同.对40岁以上CSCIWFD患者手术治疗效果优于非手术治疗.对39岁以下年轻CSCIWFD患者手术和非手术治疗预后均较差.

Objective To compare the effect of conservative and operative treatment for cervical spinal cord injury without fracture and dislocation （CSCIWFD） and to detect mechanism of injury as well as its relationship to outcome. Methods A retrospective review was conducted on 688 patients with CSCIWFD treated from August 1994 to March 2013. There were 155 patients managed conservatively （ conservation group） and 533 surgically （ operation group）. Neurological function improvement was com- pared between two groups to detect the correlation of patents＇ age and treatment methods with outcome. Results The patients were followed up for mean 17.9 months （range, 3-36 months）. Neu- rological function was estimated using Japanese Orthopedic Association （JOA） score ： （ 1 ） the recovery rate of patients aged over 40 years in operation group was better than that in conservation group （ P 〈 0.05 ） ; （2） the recovery rate in patients aged under 39 years was unsatisfactory in both groups, with in- significant difference between the two groups （ P 〉 0.05 ）. Conclusions Different age of patients with CSCIWFD has different injury mechanism, injury severity and outcome. Surgery provides better results than conservative treatment for patients aged over 40 years, but both results are poor for patients aged un- der 39 years.