成人无骨折脱位型颈髓损伤的手术策略分析

Surgical strategy analysis of cervical spinal cord injury without radiographic abnormality in adults

目的回顾性分析不同手术策略治疗成人无骨折脱位型颈髓损伤,即无放射学异常的颈髓损伤(cervical spinal cord injury without radiographic abnormality,CSCIWORA)的疗效。方法对郑州市骨科医院2013年4月至2018年4月收治的69例成年CSCIWORA病人进行回顾性分析,收集病人术前、术后6个月的美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级,比较采用前路手术、后路手术和联合入路手术病人的ASIA分级,以及伤后7 d内手术与7 d后手术病人的ASIA分级情况。结果69例病人中,24例行颈椎前路手术,32例行后路手术,13例行前后路联合手术;术中出现脑脊液漏2例,行腰大池引流后均无感染。伤后7 d内完成手术的有51例,超过7 d完成的有18例。颈椎前路手术、后路手术和前后路联合手术病人之间的手术前后ASIA分级比较,差异均无统计学意义(P均>0.05)。伤后7 d内手术与7 d后手术病人术后6个月的ASIA分级比较,差异有统计学意义(Z=-2.460,P=0.014)。结论结合影像资料,制定个体化手术入路,把握手术时机(7 d内)解除压迫、重建颈椎稳定性可使颈髓损伤修复获益更多。

Objective To retrospectively analyze the efficacy of different surgical strategies in treating cervical spinal cord injury without radiographic abnormality(CSCIWORA)in adults.Methods Total of 69 adult CSCIWORA patients admitted to Zhengzhou Orthopaedics Hospital from April 2013 to April 2018 were analyzed retrospectively.The American Spinal Injury Association(ASIA)spinal cord injury classification was collected before and after operation,the ASIA classification among the patients who underwent anterior,posterior and combined approaches,and the ASIA classification between the patients who underwent surgery within 7 days and 7 days after injury were compared.Results Among the 69 patients,24 underwent anterior cervical surgery,32 posterior surgery,13 anterior posterior combined surgery,2 had cerebrospinal fluid leakage,and no infection was found after lumbar cistern drainage.Fifty one cases completed the operation within 7 days after injury,and 18 cases completed the operation more than 7 days after injury.There was no significant difference in ASIA grade before and after operation among patients with anterior cervical surgery,posterior cervical surgery and anterior posterior combined surgery(P>0.05).There was significant difference in ASIA grade six months after operation between the patients who were operated within 7 days after injury and those who were operated after 7 days(Z=-2.460,P=0.014).Conclusion Combined with the image data,making the individualized operation approach,grasping the operation opportunity(within 7 days)to relieve the compression and reconstructing the stability of the cervical spine could benefit the injured cervical spinal cord more.