急诊手术与择期手术治疗腰椎创伤致马尾综合征疗效的比较

Comparitive Study on the Curative Effects of Emergency Operation and Selective Operation in the Treatment for Cauda Equina Syndrome Caused by Lumbar Spinal Trauma

目的比较急诊手术与择期手术治疗腰椎创伤致马尾综合征(CES)的临床疗效。方法选取2005年2月至2012年2月来武汉市武昌医院就诊的64例腰椎创伤致CES患者作为研究对象,根据手术时期选择不同将患者分为急诊手术组和择期手术组。采用美国脊柱损伤协会神经功能分级、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)和尿失禁调查问卷简表(ICIQ)比较两组患者术后2周和12个月时神经功能的恢复情况。结果急诊手术组患者术后2周及12个月后神经功能的显效率显著高于择期手术组(χ2=6.283,6.736,P<0.05),两组患者术后12个月神经功能的显效率显著高于术后2周(χ2=6.928,6.937,P<0.05);急诊手术组患者术后12个月时,ODI及ICIQ评分较择期手术组明显降低(t=5.938,7.394,P<0.05),而两组VAS评分比较无统计学意义(t=1.384,P>0.05)。结论腰椎创伤致CES患者伤后48 h内行急诊手术治疗,可明显改善患者的神经功能,提高生活质量。

Objective To compare the clinical curative effects of emergency operation and selective operation in the treatment for cauda equina syndrome caused by lumbar spinal trauma.Methods A total of 64 cases of patients with cauda equina syndrome caused by lumbar trauma treated in Wuchang hospital from Feb.2005 to Feb.2012 were selected as the research objects.According to the random number table method,these patients were divided into emergency operation group and selective operation group.The recovery status of neurological function of the two groups 2 weeks and 12 months after operationwas compared by neural function classification of ASIA,Oswestry disability index （ODI）,visual analog pain rating scale（VAS） and urinary incontinence questionnaire summary table （ICIQ）.Results The improvement rates of nerve function 2 weeks and 12 months after operation of emergency operation group were significantly higher than those of selectiveoperation group （Х^2 =6.283,6.736,P 〈 0.05）,the improvement rates of nerve function 12 months after operation of the two groups were significantly higher than those of 2 weeks after operation （Х^2 =6.928,6.937,P 〈 0.05）.ODI and ICIQ scores of emergency operation group 12 months after operation were significantly lower than those of selective operation group （t =5.938,7.394,P 〈 0.05）.There was no statistically significant difference of VAS score between the two groups （t =1.384,P 〉 0.05）.Conclusion Patients with cauda equina syndrome caused by lumbar spinal trauma should get an emergency operation within 48 h after injury,which could obviously improve the patient＇s nerve function and the quality of life.