无骨折脱位型颈髓损伤延迟期不同治疗方案的疗效观察

Therapeutic effect of different treatment regimens on cervical spinal cord injury without fracture and dislocation in delayed period

目的探讨无骨折脱位型颈髓损伤延迟期保守治疗及不同后路手术治疗方案的治疗效果.方法回顾分析2013年1月~2017年10月70例无骨折脱位型颈髓损伤延迟期就诊患者,其中采用颈后路全椎板减压侧块螺钉固定23例,采用颈后路单开门减压钛板固定23例,采用保守治疗24例.根据日本JOA脊髓功能评分,观察三种方法治疗后JOA评分改善率情况.结果本次70例随访患者,均随访1年,随访JOA改善率,3个月保守治疗组和两组后路手术组差异有统计学意义(P<0.05).单开门减压钛板固定组与全椎板切除减压侧块螺钉内固定组间差异无统计学意义(P>0.05).12个月保守治疗组和两组后路手术组差异有统计学意义(P<0.05).单开门减压钛板固定组与全椎板切除减压侧块螺钉内固定组间差异无统计学意义(P>0.05).结论对于无骨折脱位型颈髓损伤延迟期患者,手术治疗效果优于保守治疗,不同后路手术方式预后无明显差异.

Objective To investigate the therapeutic effect of conservative treatment and different posterior approach surgical treatment regimens on cervical spinal cord injury without fracture and dislocation in delayed period. Methods 70 patients with cervical spinal cord injury without fracture and dislocation in delayed period from January 2013 to October 2017 were retrospectively analyzed. Among them, 23 patients were treated with posterior cervical laminectomy and lateral block screw fixation, 23 patients were treated with single door decompression by posterior cervical approach and titanium plate fixation, 24 cases were treated with conservative method. According to the Japanese JOA spinal cord function score, the improvement rate of JOA score after three treatment methods was observed. Results All the 70 patients were followed up for 1 year. The improvement rate of JOA was followed up. The difference between the 3-month conservative treatment group and the two posterior operation groups was statistically significant(P<0.05). There was no significant difference between the single-door decompression and titanium plate fixation group and the full laminectomy decompression and lateral block screw fixation group(P>0.05). There was a statistically significant difference between the 12-month conservative treatment group and the two posterior surgery groups (P<0.05). There was no significant difference between the single-door decompression and titanium plate fixation group and the full laminectomy decompression and lateral block screw fixation group(P>0.05). Conclusion For patients with delayed cervical spinal cord injury without fracture and dislocation, the effect of surgical treatment is better than that of conservative treatment. There is no significant difference in the prognosis of different posterior approaches.