急性创伤性颈中央脊髓综合征手术时机的探讨研究

Surgical timing for acute traumatic central cord syndrome

目的探讨不同手术时机治疗急性创伤性颈中央脊髓综合征(ATCCS)的疗效。方法回顾性分析2013年1月至2021年2月河南省人民医院脊柱脊髓外科收治的84例ATCCS患者资料。按照受伤至手术治疗时间分3组,A组(<48 h手术)16例,男11例,女5例;年龄43~76岁。B组(3~7 d手术)41例,男31例,女10例;年龄41~78岁。C组(8~14 d手术)27例,男15例,女12例;年龄46~83岁。根据病情分别采用前路、后路或前后联合手术。比较3组患者的入院时、术后7 d、12个月的美国脊髓损伤协会(ASIA)运动评分和日本骨科协会(JOA)评分,术后ICU时长,并发症发生率。结果3组患者术前一般资料和手术方式比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后7 d、12个月的ASIA运动评分和JOA评分均优于入院时,术后12个月的ASIA运动评分和JOA评分均优于术后7 d,差异均有统计学意义(P<0.01)。3组患者间术后7 d和12个月的ASIA运动评分和JOA评分比较差异均无统计学意义(P>0.05)。A组术后ICU时长为42(26,61)h,显著长于B组23(16,35)h和C组24(14,38)h,差异均有统计学意义(P<0.05)。84例患者中无死亡病例,3组患者间严重并发症和一般并发症总体发生率比较差异均无统计学意义(P>0.05)。结论手术治疗ATCCS安全、有效,2周内行减压手术均可取得良好的疗效。

Objective To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome(ATCCS).Methods Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery,Henan Provincial People's Hospital from January 2013 to February 2021.According to the surgical timing,the patients were divided into 3 groups.In group A(surgery<48 hours)of 16 cases,there were 11 males and 5 females,aged from 43 to 76 years;in group B(surgery within 3 to 7 days)of 41 cases,there were 31 males and 10 females,aged from 41 to 78 years;in group C(surgery within 8 to 14 days)of 27 cases,there were 15 males and 12 females,aged from 46 to 83 years.Anterior,posterior or combined anterior and posterior approaches were used according to their specific condition.The American Spinal Injury Association(ASIA)motor scores and Japanese Orthopaedic Association(JOA)scores at admission,7 days and 12 months after operation,postoperative ICU duration,and complications were compared among the 3 groups.Results There were no significant differences in the preoperative general information or surgical approaches among the 3 groups,showing they were comparable(P>0.05).In all patients,the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission,and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation(P<0.01).There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation(P>0.05).The postoperative ICU duration in group A was 42(26,61)h,significantly longer than 23(16,35)h in group B and 24(14,38)h in group C(P<0.05).There were no deaths in the 84 patients;there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups(P>0.05).Conclusions Surgery is safe and effective for ATCCS.However,decompression surgery within 2 weeks may achieve better outcomes.