创伤性颈部脊髓损伤的外科治疗

Surgical treatment for traumatic cervical spinal cord injury

目的探讨创伤性颈部脊髓损伤的手术治疗方式及其疗效。方法回顾性分析联勤保障部队第九〇〇医院神经外科自2014年4月至2019年10月因创伤性颈部脊髓损伤行手术治疗的75例患者的临床资料。采用颈椎前路椎间盘切除减压融合术26例,颈椎前路椎体次全切除减压融合术13例,颈椎后路椎板切除/脊髓内减压+侧块/椎弓根螺钉内固定术29例,颈后路“单开门”式椎管扩大成形术7例。通过术前及术后末次随访的美国脊髓损伤协会脊髓损伤评分(AIS)评估手术疗效。结果随访3~31个月,术后末次随访AIS较术前明显改善(Z=-6.992,P<0.001)。术中无大血管、气管、食道损伤及脊髓意外发生。术后死亡2例,脑脊液漏2例,伤口愈合不良3例。无颈椎后凸畸形发生,无内固定物断裂、脱落。结论对于急性创伤性颈部脊髓损伤患者,根据脊髓受压来源及范围,及早采取合适的入路与术式进行手术,可取得较好的疗效。

Objective To investigate the operative method and curative effect of traumatic cervical spinal cord injury.Methods A total of 75 hospitalized patients with traumatic cervical spinal cord injury in Neurosurgery Department of the 900th Hospital of Joint Logistics Team from April 2014 to October 2019 were retrospectively analyzed.Anterior cervical discectomy and fusion was performed in 26 cases,anterior cervical corpectomy and fusion in 13 cases,posterior laminectomy/myelotomy+lateral mass/pedicle screw fixation in 29 cases,and posterior“single door”laminoplasty in 7 cases.The curative effect was evaluated by American Spinal Cord Injury Association impairment scale(AIS)before and at the last follow-up.Results All patients were followed up for 3-31 months and the AIS at the last time after operation was significantly improved compared with that before operation(Z=-6.992,P<0.001).No major vessel,trachea,esophagus injury and spinal cord accident occurred during the operation.There were 2 cases of death,2 cases of cerebrospinal fluid leakage and 3 cases of poor wound healing.There was no kyphosis of cervical spine,no fracture or fall off of internal fixation.Conclusion For the patients with acute traumatic cervical spinal cord injury,according to the source and scope of spinal cord compression,appropriate approach and operation mode should be adopted as soon as possible,which can achieve better curative effect.