无骨折脱位型颈脊髓过伸伤的特点及手术疗效观察

Characteristics and surgical curative effect observation of hyperextension injury of cervical spinal cord without fracture or dislocation

目的分析无骨折脱位型颈脊髓过伸伤的特点并评估其手术疗效。方法回顾性分析我院2013年2月~2015年5月收治的15例经手术治疗的无骨折脱位型颈脊髓过伸伤患者的临床资料,采用ASIA分级标准,评估神经功能障碍及其改善情况。结果 15例患者均为过伸性损伤,入院后根据具体情况行前路或后路手术。术后所有患者均获得随访,随访时间14~41个月,平均(22.4±8.6)个月。术前ASIA评级B级3例,C级6例,D级6例;末次随访时C级1例,D级7例,E级7例。ASIA评级术后1周改善0.7级,术后3个月改善0.8级,术后半年、1年及末次随访改善均为1.2级。结论椎管狭窄是无骨折脱位型颈脊髓过伸伤的主要病理基础,过伸性损伤是发生颈髓损伤的直接原因,不完全性脊髓损伤是其临床特点。对于有明显椎管狭窄、脊髓受压、颈脊髓水肿变性的患者,手术疗效明确。

Objective To analyze the characteristics of hyperextension injury of cervical spinal cord without fracture or dislocation and to evaluate the effect of surgical curative effect.Methods 15 cases of hyperextension injury of cervical spinal cord without fracture or dislocation treated surgically in our hospital from February 2013 to May 2015 were ret- rospectively reviewed.Neurological impairment and improvement were assessed using the ASIA system.Results All 15 patients were hyperextension injury.All patients were followed up for 14-41 months,with an average of （22.4 ＋8.6） months.Preoperative ASIA rating showed that there were 3 cases in grade B,6 cases in grade C,and 6 cases in grade D. At the last follow-up,1 case was grade C,7 cases were grade D,7 cases were grade E.The improvement was 0.7 at 1 weeks after surgery in the ASIA rating,and the improvement was 0.8 at 3 months after surgery,the improvement was 1.2 at six months,1 years and the last follow-up after surgery.Conclusion Spinal stenosis is the main pathological basis of hyperextension injury of cervical spinal cord without fracture or dislocation,hyperextension injury is the direct cause of spinal cord injury,incomplete spinal cord injury is its clinical features.For significant spinal stenosis,spinal cord com- pression,cervical spinal cord edema in patients with degeneration,surgical treatment effect is significant.