不同手术时机对无骨折脱位型颈脊髓损伤患者术后恢复的影响

Influence of different operation timing on postoperative recovery of patients with cervical spinal cord injury without fracture and dislocation

目的分析不同手术时机对无骨折脱位型颈脊髓损伤患者术后恢复的影响。方法选取2018年10月至2019年10月在我院医治的90例无骨折脱位型颈脊髓损伤患者作为研究对象,根据手术时机的不同将其分为三组,将在伤后3 d内进行手术治疗的30例患者作为A组,将在伤后3~7 d进行手术治疗的30例患者作为B组,将在伤后14 d内进行手术治疗的30例患者作为C组。比较三组脊柱功能、神经功能、神经功能改善率、颈椎功能障碍评分。结果治疗后1、6、12个月,三组的JOA评分均较治疗前上升,且B组上升幅度高于A组和C组(P<0.05)。治疗后1、6、12个月,三组的ASIA评分均较治疗前上升,且B组上升幅度高于A组和C组,A组上升幅度高于C组(P<0.05)。治疗后1、6、12个月,B组的运动神经功能改善率高于A组、C组,A组高于C组(P<0.05)。治疗后1、6、12个月,三组的NDI评分均较治疗前下降,且B组下降幅度高于A组和C组,A组下降幅度高于C组(P<0.05)。结论早期开展手术治疗无骨折脱位型颈脊髓损伤患者有利于减少脊髓继发性损伤,加快脊髓功能恢复,其中在伤后3~7 d选择手术可获得最佳的效果。

Objective To analyze the influence of different operation timing on postoperative recovery of patients with cervical spinal cord injury without fracture and dislocation.Methods A total of 90 patients with cervical spinal cord injury without fracture and dislocation treated in our hospital from October 2018 to October 2019 were selected as the research objects.The patients were divided into three groups according to the different operation timing.The 30 patients who underwent operation within 3 d after injury were taken as group A,30 patients who underwent operation at 3-7 d after injury were taken as group B,30 patients who underwent operation within 14 d after injury were taken as group C.The spinal function,neurological function,improvement rate of neurological function and cervical dysfunction score were compared among the three groups.Results At 1,6 and 12 months after treatment,the JOA score of the three groups were higher than those before treatment,and the rising range of the group B was higher than that of the group A and the group C(P<0.05).At 1,6 and 12 months after treatment,the ASIA score of the three groups were higher than those before treatment,and the rising range of the group B was more than that of the group A and the group C,and the rising range of the group A was more than that of the group C(P<0.05).At 1,6 and 12 months after treatment,the improvement rate of neurological function in the group B was higher than that in the group A and the group C,and that in the group A was higher than the group C(P<0.05).At 1,6 and 12 months after treatment,the NDI score of the three groups decreased compared with those before treatment,and the decreasing range of the group B was more than that of the group A and the group C,and the decreasing range of the group A was more than that of the group C(P<0.05).Conclusion Early surgical treatment of patients with cervical spinal cord injury without fracture and dislocation is conducive to reduce secondary spinal cord injury and accelerate the recovery of spinal cord function.The best effect can be obtained by selecting surgery at 3-7 d after injury.