老年人颈椎过伸性颈髓损伤的特征

Characteristic of extension injury of cervical spinal cord in the elderly

目的:评价老年人颈椎过伸颈髓损伤的特征。探讨手术与非手术治疗在老年急性颈椎过伸颈髓损伤中作用。方法:对31例老年颈椎损伤进行回顾性分析,分为手术治疗组和非术治疗组。手术治疗21例(其中颈椎前路手术减压术3例,后路减压术8例,单开门椎管成形术4例,双开门椎管扩大成形术6例)。非手术治疗10例。颈脊髓损伤神经功能恢复按Frankel分级。结果:经过随访观察1.0～1.5年,脊髓神经功能恢复情况:按Frankel分级,保守治疗组治疗后A级1例,B级2例,C级2例,D级2例,E级3例。手术治疗组治疗后A级1例,B级2例,C级2例,D级6例,E级10例。手术组比非手术组疗效满意。结论:老年颈椎损伤的发生率逐渐增加,病死率较高,在诊断和治疗上应给予积极和特殊考虑。尽管老年人颈椎过伸颈髓损伤属高危疾病人群,但如果能耐受手术,获得早期手术减压,可有利于损伤的颈脊髓神经功能得到较好的恢复。

AIM:To evaluate characteristic of elderly patients with the extension injury of cervical spinal cord and to investigate effect of operation and non operation therapy on acute extension injury of cervical spinal cord. MEHODS:Thirty one elderly patients with extension injury of cervical spinal cord,divided into surgical treatment group(21 cases) and conservative treatment group(10 cases)were retrospectively analyzed.Three cases were performed the anterior approach decompression of the cervical vertebra,eight patients were performed the posterior approach decompression,four patients were performed mono door vertebra canal amplification plasty and 6 patients were double door vertebra canal amplification plasty of the cervical vertebra.According to Frankel grade,nerve functional restoration of spinal cord injury were described. RESULTS:A follow up of 1.0-1.5 years was performed in all patients.According to Frankel grade,nerve functional restoration of spinal cord injury was:1 case of grade A,2 cases of grade B,2 cases of grade C,2 cases of grade D and 3 cases of grade E in conservative treatment group,1 case of grade A,2 cases of grade B,2 cases of grade C,6 cases of grade D and 10 cases of grade E in surgical treatment group.The nerve functional restoration of the surgical treatment group was superior to the conservative treatment group. CONCLUSION:The incidence of cervical spinal cord injury increases gradually and fatality rate grows higher than before in the elderly.Positive and special consideration should be taken in the diagnosis and treatment.Though elderly patients with extension injury of cervical spinal cord belong to crowds of the high risk disease,nerve function restoration of spinal cord injury can be obtained well if the elderly patients can tolerate operative treatment and earlier period decompression.