无骨折脱位的急性中央型颈髓损伤

Acute Central Cervical Cord Injury without Fracture and Dislocation

目的 :描述无骨折脱位的急性中央型颈髓损伤的临床特点。方法 :收治 2 1例无骨折脱位的急性中央型颈髓损伤 ,男 16例 ,女 5例 ,平均年龄 5 7.4岁。随访时间 3个月～ 2年。记录所有病例入院时和终末随访时的ASIA运动评分 ,分析颈椎MRI的表现 ,全部病例经保守治疗后 ,其中有 6例手术治疗。结果 :神经功能均有不同程度改善 ,全组、保守治疗组和手术治疗组各自治疗前后ASIA运动评分有差异 (P <0 .0 1) ,而保守治疗组和手术治疗组治疗前后评分差值之间无差异 (P >0 .0 5 ) ,多数病例遗留手内在肌功能有不同程度损害。结论 :无骨折脱位的急性中央型颈髓损伤的临床特点是 :发病率并不低 ;其损伤机制是多原有颈椎退变 ,受伤时颈过伸 ,使颈髓前后受夹压 ,使脊髓灰质损伤重于白质 ;保守治疗效果较满意 ,手术治疗应慎重 ,后期手术提倡前路减压、融合。

Objective:To describe clinical feature of acute central cervical cord injury without fracture and dislocation.Methods:Twenty one patients with this syndrome were treated.The ASIA motor scores of every case were recorded at admit and last follow up respectively.All cases were conservatively treated firstly,and 6 cases were surgically treated later.Result:The ASIA motor scores increased significantly after treatment,but the increasing range between conservative group and surgical group was not different statistically.Conclusion:The incidence of acute central cervical cord injury without fracture and dislocation is not rare.It mainly results from a hyperextension force to patient with spinal canal narrowing.The result is often satisfactory by conservative therapy.Anterior approach is recommended for surgical intervention.