外科手术脊髓松解减压对脊髓损伤患者功能恢复的影响

Effects of surgical decompression on the functional recovery in patients with spinal cord injury

目的探讨外科手术脊髓松解减压在脊髓损伤（spinal cord injury,SCI）患者功能恢复中的作用。方法 2012年1月至2014年12月,我院行外科手术脊髓松解减压治疗的SCI患者16例,其中男13例,女3例,年龄23-61岁,平均（38.56±10.77）岁;随访3-24个月,平均（18.44±10.06）个月,损伤程度根据美国脊髓损伤协会（American spinal injury association,ASIA）评分分级。所有患者均纵行切开硬膜显露脊髓,探查确定脊髓浅表软化区或瘢痕区,纵切,清创,髓内减压。配合术后早期康复治疗。采用ASIA评分、Barthel指数及功能独立性测量（functional independence measurement,FIM）评定患者的功能状况。结果经过外科手术脊髓松解减压治疗后,SCI患者的ASIA分级较治疗前明显改善,Barthel指数术后评分（45.00±29.72）分较术前（30.31±24.25）分显著提高,差异有统计学意义（P〈0.05）,FIM术后评分（79.69±16.42）分较术前（61.13±14.21）分显著提高,差异有统计学意义（P〈0.01）。结论 SCI患者经过外科手术脊髓松解减压治疗后,运动功能和生活自理能力（activities of daily living,ADL）得到明显提高和改善,促进其尽早回归家庭和社会。

Objective To explore the effects of surgical decompression on the functional recovery in patients with spinal cord injury（ SCI）. Methods From January 2012 to December 2014, 16 patients with SCI received surgical decompression, including 13 males and 3 females. The average age was（ 38.56 ± 10.77） years（ range： 23- 61 years）. The average follow-up time was（ 18.44 ± 10.06） months（ range： 3- 24 months）. For each patient, a longitudinal incision was made in the dura to expose the spine to determine the spinal cord superficial softening zone, and finally longitudinal incision, debridement and decompression were done. The functional recovery was assessed by the American Spinal Injury Aassociation（ ASIA） standards, Barthel index and Functionl Independence Measurement（ FIM）. Results After the surgical decompression, functional recovery was effectively improved in patients with SCI. According to the ASIA standards, the function was significantly improved after the surgery compared with that before the surgery. The Barthel index score was（ 30.31 ± 24.25） points before the surgery, which was significantly increased to（ 45.00 ± 29.72） points postoperatively with statistical significance（ P 0.05）. The FIM score was（ 79.69 ± 16.42） points before the surgery, which was significantly increased to（ 61.13 ± 14.21） points postoperatively with statistical significance（ P〈 0.01）. Conclusions The motor function and ability of daily life（ ADL） in patients with SCI are significantly improved after surgical decompression, facilitating their returning to family and society.