无骨折脱位型颈脊髓损伤手术疗效和预后的影响因素

Cervical spinal cord injury without fracture and dislocation:clinical outcomes of surgical treatment and related factors of prognosis

目的探讨无骨折脱位型颈脊髓损伤患者的手术疗效,以及影响其预后的因素。方法对46例无骨折脱位型颈脊髓损伤的患者行手术治疗。比较手术前和术后1周、3个月、6个月、12个月患者的运动评分和感觉评分(针刺觉评分、轻触觉评分),分析年龄、性别、术前病程、有无颈椎基础疾病、MRI检查有无脊髓内信号改变、术前运动评分和感觉评分对患者预后的影响。结果术后1周、3个月、6个月、12个月患者的运动评分、针刺觉评分和轻触觉评分均显著高于术前(P<0.01)。术后12个月,年龄<55岁与年龄≥55岁患者间、男性与女性患者间,以及有脊髓内信号改变与无脊髓内信号改变患者间的运动评分、针刺觉评分和轻触觉评分的差异均无统计学意义(P值均>0.05);术前病程<1周和无颈椎基础疾病患者的运动评分、针刺觉评分和轻触觉评分均显著高于术前病程≥1周和有颈椎基础疾病患者(P值均<0.05);术前运动评分≥50分、术前针刺觉评分≥56分和术前轻触觉评分≥50分患者的运动评分、针刺觉评分、轻触觉评分分别显著高于术前运动评分<50分、术前针刺觉评分<56分和术前轻触觉评分<50分的患者(P值均<0.05)。结论手术治疗能显著改善无骨折脱位型颈脊髓损伤患者的预后,术前病程、颈椎基础疾病、术前运动和感觉(针刺觉评分和轻触觉评分)评分对患者预后有影响,年龄、性别和MRI检查有无脊髓内信号改变对患者预后无影响。

Objective To investigate the surgical outcomes and prognostic factors of patients with cervical spinal cord injury without fracture and dislocation （CSCIWOFD）. Methods A total of 46 CSCIWOFD patients underwent surgical treatment in our hospital. American Spinal Injury Association （ASIA） scores including motion score and sensing score （acupuncture and light touch） were recorded before surgery, 1 week, 3 months, 6 months and 12 months after surgery. The relationship between prognosis and related factors （age, sex, course of disease, preoperative cervical disorders, MRI signal changes in spinal cord and preoperative ASIA scores） were analyzed. Results ASIA scores were increased significantly 1 week, 3 months, 6 months and 12 months after surgery （all P〈0.01）. Twelve months after surgery, there were no significant differences in ASIA scores between the patients aged〈55 years and those aged≥55 years, between male and female patients, or between the patients with and without MRI signal changes in spinal cord （all P〉0.05）. Twelve months after surgery, ASIA scores in the patients who had no preoperative cervical disorders and in whom the course of disease was less than one week were significantly higher than those who had preoperative cervical disorders and in whom the course of disease was one week and more （all P〈0.05）. Twelve months after surgery, ASIA scores in the patients who had higher preoperative ASIA scores （motion score≥50, acupuncture score≥56 and light touch score≥50） were significantly higher than those with lower preoperative ASIA scores （motion score,〈50, acupuncture score〈56 and light touch score〈50, all P-〈0.05）. Conclusion Surgical treatment can improve prognosis in patients with CSCIWOFD. The course of disease, preoperative cervical disorders and preoperative ASIA score are correlated toprognosis. However, age, sex, and MRI signal changes in spinal cord have no effects on prognosis.