颈椎中央型脊髓损伤的手术治疗

Surgical Treatment of the Central Cervical Spinal Cord Injury

自的 探讨颈椎中央型脊髓损伤的治疗及预后。方法 11例均为男性,年龄36～65岁,交通事故9例,跌伤1例,头部砸伤1例,病程2 h～14 d,伤后经临床及MRI检查,确诊为颈部中央型脊髓损伤,伴颈椎间盘突出9例,颈椎管狭窄1例,C_6椎体骨折1例。MRI显示:脊髓单处损伤9例,二处损伤2例。伤后4～20 d手术治疗,9例行前路颈椎间盘摘除植骨钢板内固定,2例行颈椎后路减压植骨侧块钢板内固定。结果 随访6～12个月,平均8个月。11例患者均取得了满意疗效,平均肌力恢复2～5级,复查内固定牢靠、在位,植骨愈合良好。结论 颈椎中央型脊髓损伤是一种以上肢重于下肢为临床特征的颈段脊髓损伤,多见于有颈椎管狭窄等病理基础,临床体检和MRI影像上有表现,一旦确诊提倡以手术为主的综合性治疗措施,手术尽可能去除致病因素,其他辅助措施则以促进脊髓功能恢复为目的。

Objective To discuss the surgical treatment of the central cervical spinal cord injury. Methods Eleven cases of the central cervical spinal cord injury were male, with age ranged from 36 - 65 years. Of 11 cases, traffic accident 9 cases, fell down 1 case, head squashed 1 case, checked by clinic and MRI, the diagnosis was definite. The MRI show that the cervical spinal cord was injured with disc protrusion (9 cases), cervical spinal stenosis (1 case) and fractue of the C6 body (1 case). The surgical treatment was done after 4~20 days wounded. Anterior decompression was 9 cases, fixed by Orion or Zephir plate and having bone grafting. Posterior decompression was 2 cases, fixed by axis plate and having bone grafting. Results All the cases were followed up from 6~ 12 months. The clinical outcomes were excellent in 11 cases, the myodynamia recovered 2~5 grades, the bone grafting fused completely, and the plates fixed firmly. Conclusion The central cervical cord syndrome is characterized by greater motor impairement in the upper extremities with minimal lower extremity involvement. It is common that companied with cervical spinal stenosis. MRI is the best way to diagnosis this lesion. Once we define this lesion, the surgical treatment combin with another multiple-treatment is the best way to cure.