老年挥鞭伤早期手术和经保守治疗后转手术的疗效比较

Early Surgery Versus Surgery after Physiotherapy Treatment of Elderly Whiplash Injury

目的:回顾性研究老年挥鞭伤患者行早期手术与保守治疗后转行手术治疗的临床疗效。方法:在2006年6月-2011年10月收治并随访的103例老年挥鞭伤患者中,有57例行早期手术治疗,46例经保守治疗后转行手术治疗。用改良的日本骨科协会评分法(mJOA)、颈椎功能障碍指数(NDI)、疼痛视觉评分(VAS)以及术后相关并发症来评价两组治疗前及术后随访时的患者状况。结果:103例患者术后均获得至少24个月随访。早期手术组和保守治疗后转手术治疗组的术后mJOA评分、NDI指数及VAS评分较入院时均有改善,而早期手术组术后随访的临床疗效明显优于保守治疗后转手术治疗组,2组比较差异有统计学意义(P<0.05)。保守治疗后转手术组术后出现肺炎9例,发热11例;早期手术组出现肺炎1例,发热3例,2组比较差异有统计学意义(P<0.01),2组并发症比较差异无统计学意义(P>0.05)。结论:老年挥鞭样损伤患者行早期手术治疗的疗效优于经保守治疗后转行手术的疗效,并且术后并发症也相对较少。

Objective：To compare retrospectively the functional outcomes of elderly patients with whiplash injury undergoing early surgery（36h）and surgery after physiotherapy treatment（〉10w）.Methods：A retrospective analysis was done for 103 patients with whiplash injury who had been treated in our department from June 2006 to December 2011 and followed up.Fifty-seven cases underwent early surgery and forty-six cases received conservative treatment for a maximum of 10 weeks before surgery.Patients were asked to use Neck Disability Index（NDI）,the modify Japanese orthopedics association（mJOA）score,and the neck pain visual analogue scale（VAS）score to evaluate the functional and disability-related outcomes.Treatment-related complication data were collected and all the complication rate will be analyzed by statistics.Results：Both groups had significant postoperative improvement in NDI scores,mJOA score and VAS score（P〈0.05）,and early surgery group resulted in better outcomes than surgery after physiotherapy group among these parameters（P〈0.05）.In the surgery after physiotherapy group nine patients experienced pneumonia and eleven patients had a fever symptom,except for the significant between-group differences in pneumonia and fever were found,there were no obviously statistical difference in the other complication indicators.Conclusion：For the elderly patients with whiplash injury,early surgical intervention is a better choice than surgery after a long time physiotherapy.