单纯上肢受累型与四肢受累型急性中央颈脊髓损伤的临床特点

Clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement

目的比较分析单纯上肢受累型与四肢受累型急性中央颈脊髓损伤的临床特点。方法采用回顾性病例对照研究分析2010年1月-2013年12月收治的无骨折脱位型急性中央颈脊髓损伤患者76例。根据神经损伤累及范围，分为单纯上肢受累组（上肢组，39例）和四肢受累组（四肢组，37例）。上肢组男35例，女4例；年龄21—80岁[（52．5±13．4）岁]。致伤原因：交通伤24例，平地摔伤8例，高处坠落6例，重物砸伤1例。损伤节段：C3/4 16例，C4/5 14例，C5/6 9例。四肢组男30例，女7例；年龄36～78岁[（59．6±9．7）岁]。致伤原因：交通伤16例，平地摔伤11例，高处坠落7例，重物砸伤3例。损伤节段：C3/4 9例，C4/518例，C5/6 10例。测量两组损伤节段椎管矢状径、最大椎管组成及最大脊髓压迫，记录颈椎相关退变因素、治疗方案。采用美国脊髓损伤协会（ASIA）评分标准评价入院及末次随访时上肢运动功能。结果上肢组和四肢组损伤节段椎管矢状径[（7．5±1．5）mm：（6．8±1．2）mm]、最大椎管组成[（28．9±9．6）％：（34．9±10．6）％]、入院时ASIA评分[（31．6±11．8）分：（22．7±11．3）分）]、末次随访时ASIA评分[（46．2±4．2）分：（40．2±4．0）分]方面差异有统计学意义（P〈0．05）；而最大脊髓压迫[（15．7±11．9）％：（17．0±10．6）％]差异无统计学意义（P〉0．05）。在退变因素方面，上肢组的椎体后缘骨赘的发生率（15％）要低于四肢组（51％）（P〈0．01）。上肢组20例（49％）选择手术治疗，四肢组31例（84％）选择手术治疗（P〈0．05）。结论相较于四肢受累型患者，单纯上肢受累型急性中央颈脊髓损伤更多见于年轻患者，椎体后缘骨赘的发生率低，椎管内缓冲空间大，受到的神经损伤程度较轻，更倾向于非手术治疗，预后较好。

Objective To compare and analyze the clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement. Methods A retrospective case control study was made on clinical data of 76 patients with acute central cervical spinal cord injury hospitalized from January 2010 to December 2013. Nerve injury involved was only upper extremity in 39 patients （ upper extremity group ）, but both upper and lower extremities in 37 patients （ upper-and lower-extremity group）. In upper extremity group, there were 35 males and four females, age was 21-80 years [（52. 5 ± 13. 4）years], injury resulted from traffic accidents in 24 patients, ground-level falls in eight, high-level falls in six and heavy-object hit in one, and level of injury was C3/4in 16 patients, Ca/sin 14 and C5/6in nine. In upper- and lower-extremity group, there were 30 males and seven females, age was 36-78 years [ （ 59.6± 9.7 ） years ] , injury resulted from traffic accidents in 16 patients, ground-level fails in 11, high-level falls in seven and heavy- object hit in three, and level of injury was C3/4in nine patients, C4/sin 18 and Cs/6in 10. Sagittal diameter of the cervical spinal canal, maximal canal compromise, maximal spinal cord compression, degenerating factors of the cervical spine and treatment protocols were determined. Upper extremity function was assessed with the American spinal injury association （ASIA） score. Results There were significant differences between upper extremity group and upper- and lower-extremity group in sagittal diameter of the cervical spinal canal [ （7.5 ±1.5）mm ： （6. 8 ±1.2）mm], maximal canal compromise [ （28.9 ±9.6）% ： （34.9 ± 10. 6） % ], ASIA score at admission [ （ 31.6 ± 11.8 ） points ： （22.7 ± 11.3） points） ] and ASIA score at last follow-up [ （46.2±4. 2）points ： （40.2±4.0）points] （P 〈0.05）, while the maximal spinal cord compression in upper extremity group [ （15.7±11.9）% ] had no significant difference from that in upper- and lower- extremity group [ （ 17.0± 10.6） % ] （P 〉 0.05 ）. Lower prevalence of posterior osteophyte of the vertebral body was noted in upper extremity group than upper- and lower-extremity group （15% ： 51% ） （P 〈0.01 ）. Twenty patients （49%） in upper extremity group were surgically treated, while 31 patients （84%） in upper- and lower-extremity group （P 〈 0. 05）. Conclusions Compared to acute central cervical spinal cord injury with both upper and lower extremity involvement, the injury with only upper extremity involvement is much common in younger patients and is characterized by lowered frequency of osteophyte, large buffer space, mild nmve damage, preferred non-operation treatment and good prognosis.