脊髓损伤晚期前路减压手术对脊髓功能恢复的近期效果

Recent effect of anterior decompression on the functional recover of cord in late spinal cord injury

目的:探讨晚期前路减压手术治疗脊髓损伤的手术指征和时限。方法:晚期脊髓损伤伴脊髓压迫症患者56例,均行脊髓前路减压术,脊柱失稳者同时行内固定手术。术前和术后使用美国脊柱损伤协会(ASIA)评估标准进行疗效评价。结果:术后影像学检查证实所有患者完全去除脊髓腹侧压迫,恢复椎管直径。随访20d～6个月(平均30d),53例获得不同程度脊髓功能改善,表现为肢体痉挛减轻、泌汗功能改善、根性疼痛减轻、感觉平面下移、肌力增加、肛周感觉部分恢复以及排尿功能改善。ASIA运动分由术前(32.8±19.5)分增加到(39.7±18.0)分;触觉分由(44.2±21.6)增到(54.8±15.3)分;痛觉分由(46.5±22.0)分增至(55.1±15.9)分。结论:①脊髓前路减压能准确、彻底地解除脊髓腹侧之压迫,改善晚期脊髓损伤包括全瘫患者同一平面神经根和脊髓长束的功能。脊髓、神经受压时间长短在临床上只具有相对意义,不是影响手术治疗效果的主要因素。手术时限与长期效果的关系有待进一步评价。②晚期前路减压的手术指征应放宽,凡影像学检查证实脊髓腹侧存在压迫和/或严重后突畸形者均应彻底减压。③减压时应注意保持和恢复脊柱的稳定性,必要时内固定。

AIM:To explore the indications and time limit of anterior decompression for spinal cord injury (SCI) in late period. METHODS:Fifty six patients with SCI accompanied with spinal compression were involved in the study. All the patients took the anterior decompression, besides, those with unsteady spine were followed by internal fixation. The spinal cord function was assessed by using the American Spinal Injury Association (ASIA)Classification before and after the operation. RESULTS:Postoperative imaging examination revealed the displaced fragments of bone or disc compressing the anterior aspect of the spinal cord were resected totally in all patients. The short term follow up varied from 20 days to 6 months with an average of 30 days. The spinal cord function improved at different levels in 53 cases, it was showed by the relief of limb spasticity, amelioration of sweat, relief of radicular pain, descend of the sensory level, improvement of motor function, anal sensation recovery around anus and the amelioration of miction function. better sphincter control and bladder function.ASIA motor scores increased from (32.8±19.5) pre operation to (39.7±18.0) post operation, light touch scores increased from(44.2±21.6) to (54.8±15.3), pin prick scores increased from(46.5±22.0) to (55.1±15.9). CONCLUSION:①Anterior decompression can relieve the compression of spinal ventral exactly and completely, and ameliorate the late SCI. The compression duration of spinal cord and nerve only has clinical relative significance, but isn't the main factor that influences the effect of operation. The relation between the time limit and long term effect of operation is to be evaluated further.②The indication for late anterior decompression should be broadened, all patients with compression in the anterior spinal cord and/or severe kyphosis proved by imaging examination should be decompressed completely.③The stability of spine should be considered during anterior decompression, internal fixation is used if necessary.