前路减压手术治疗晚期脊髓损伤的初步报告

Late Anterior Decompression for Treatment of Spinal Cord Injury: A Preliminary Result

目的 探讨前路减压手术治疗晚期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 5 6例 ,由受伤至本次手术的时间为 0 .5～ 31年 ,平均 3.6年。脊柱骨折部位 :颈 4～胸 1为 19例 ,胸 2～胸 9为 9例 ,胸 11～胸 2为 2 8例。瘫痪程度 :完全瘫痪 4 6例 ,不全瘫 10例。所有患者均行脊髓前路减压术 ,脊柱失稳者同时行内固定手术。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 2 0d～ 6个月 (平均 30d) ,5 3例 (有效率 94 .6 % )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。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。②晚2 0 0 3 0 8 0 7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。

Objective To study the indications and time limit of late anterior decompression for spinal cord injury (SCI). Methods Between January and December 2002, 56 patients with late SCI secondary to fracture or dislocation of the spine were admitted for treatment. The interval between the sustained injury and the operation performed varied from 0.5 to 31 years (mean 3.6 years). The location of spinal fracture was between C 4 and T 1 in 19 patients, T 2-T 9 in 9, and T 11 -L 2 in 28. Complete paralysis was present in 46 patients and incomplete injury in 10. Radiographic examinations revealed that there were demonstrable bone and disc fragments compressing the anterior spinal cord and/or kyphotic deformities in all patients. Anterior decompression was carried out followed by internal fixation if necessary. Results Postoperative imaging examinations revealed that displaced fragments of bone or disc compressing the anterior aspect of the spinal cord were resected totally in each patient. The short-term follow-up varied from 20 days to 6 months with an average 30 days. Of the 56 patients, 53 achieved substantial neurological improvement at different degree including improvement of the limb spasticity, recovery of the sweat, relief of the radicular pain, descend of the sensory level, improvement of motor function, anal sensation recovery and better sphincter control and bladder function. There is no worse case after surgery. The total effective rate is 94.6%. Conclusion ①Late anterior decompression and fusion benefits the neurologic recoveries of patients with SCI including incomplete and complete cord syndromes. The results indicate that the patients who were operated in 1～2 years after injury not necessarily get much better results than those operated upon 5～10 years after injury. Further research into the relation between the long-term outcome of operation and the operative time will be required. ② The indications for late anterior decompression are all patients who sustain a mass compressing of the anterior spinal cord and/or severe kyphosis proven by the radiographic examination. Complete decompression should always be attempted. ③ The stability of spine should be considered in old SCI cases during anterior decompression. The selection of some stabilization procedure should be conducted based on the associated osseous and ligamentous traumatic pathology.