不同入路手术治疗无骨折脱位型颈脊髓损伤的效果及对MRI影像学参数、脊髓功能的影响

The Effect of Different Approaches in the Treatment of Cervical Spinal Cord Injury Without Fracture and Dislocation and Its Influence on MRI Imaging Parameters and Spinal Cord Function

目的探讨不同入路手术在无骨折脱位型颈脊髓损伤(CSCIWFD)中的应用。方法选取2020年1月~2021年1月符合纳排标准的96例CSCIWFD患者,采用完全随机化法分为两组,A组的48例采取前路减压植骨融合内固定术,B组的48例采取后路减压植骨融合内固定术。观察两组手术相关指标、术后融合、手术前后脊髓神经功能[脊髓损伤(ASIA)分级、颈椎(JOA)分数]、影像学主要参数[弥散系数(ADC)、向异性(FA)、最大脊髓压迫(MSCC)]、血清免疫球蛋白(Ig)含量及并发症。结果A组手术、术后下床活动及术后住院时间均短于B组,且术中出血量少于B组(P<0.05);术后6个月、12个月两组ASIA分级、JOA评分均较术前升高(P<0.05),但两组上述指标相比,无显著差异(P>0.05);A组坚强植骨融合时间短于B组,术后3个月时融合率91.67%高于B组70.83%(P<0.05);术后6个月、12个月两组ADC、FA、MSCC均较术前降低,且术后6个月A组低于B组(P<0.05);术后6个月、12个月两组血清IgG较术前降低,且术后6个月A组IgG水平低于B组(P<0.05),术后6个月、12个月两组血清IgA、IgM水平相比,无显著差异(P>0.05);A组并发症发生率4.17%与B组8.33%相比,无显著差异(P>0.05)。结论前路、后路手术治疗CSCIWFD,均能使损伤节段获取良好的稳定性,恢复脊髓神经功能。但需根据患者实际情况,如损伤部位、损伤类型、脊髓受压部位,个体化地选择入路方式是手术成功关键。

Objective To investigate the application of different approaches in cervical spinal cord injury without fracture and dislocation(CSCIWFD)and its effect on MRI imaging parameters and spinal cord function.Methods 96 CSCIWFD patients who met the inclusion and row criteria from January 2020 to January 2021 were selected and divided into two groups by complete randomization.48 patients in group A received anterior decompression,bone grafting,fusion and internal fixation,and group B 48 cases underwent posterior decompression,bone grafting,fusion and internal fixation.The operation-related indexes,postoperative fusion,spinal nerve function before and after surgery[American Spinal Injury Association(ASIA)injury classification,Japanese Orthopaedic Association(JOA)score],main imaging parameters[diffusion coefficient(ADC),anisotropy]were observed in the two groups.(FA),maximum spinal cord compression(MSCC),serum immunoglobulin(Ig)levels and complications.Results The operation,postoperative ambulation and postoperative hospital stay in group A were shorter than those in group B,and the intraoperative blood loss was less than that in group B(P<0.05).JOA scores were all higher than those before operation(P<0.05),but there was no significant difference in the above indicators between the two groups(P>0.05);The fusion time of strong bone graft in group A was shorter than that in group B,and the fusion rate at 3 months after operation was 91.67%higher than 70.83%in group B(P<0.05);The ADC,FA and MSCC of the two groups were decreased at 6 months and 12 months after operation compared with those before operation,and group A was lower than group B at 6 months after operation(P<0.05).The serum IgG levels of the two groups at 6 months and 12 months after operation were lower than those before operation,and the IgG level of group A was lower than that of group B at 6 months after operation(P<0.05).There was no significant difference in serum IgA and IgM levels between the two groups at 6 months and 12 months after operation(P>0.05);The complication rate of group A was 4.17%compared with 8.33%of group B,there was no significant difference(P>0.05).Conclusion Both anterior and posterior approaches for the treatment of CSCIWFD can achieve good stability of the injured segment and restore spinal nerve function.However,according to the actual situation of the patient,such as the injury site,injury type,and spinal cord compression site,individualized selection of the approach is the key to successful surgery.