颈椎过伸性损伤的手术治疗
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摘要
目的探讨颈椎过伸性损伤手术治疗方法的选择及疗效。方法 2012年1月至2015年6月收治颈椎过伸性损伤患者83例,其中男63例,女20例;年龄25~78岁,平均58.5岁。所有患者均伴有脊髓神经损伤,按Frankel分级,A级4例,B级18例,C级32例,D级29例。所有患者均行手术治疗,其中72例行颈前路减压植骨融合钢板内固定术,11例行颈后路减压椎板成形术+侧块螺钉/椎弓根螺钉内固定术。结果所有患者经9~18个月随访,均获得骨性融合,无内固定失败;比较两组手术前、后的Frankel分级变化和ASIA评分改变。两组术后脊髓功能均较术前有明显改善;Frankel分级平均提高1~2级,前路组ASIA评分增加(26.2±5.4)分(P=0.019),后路组ASIA评分增加(15.2±6.1)分(P=0.036);前路减压、植骨内固定较后路减压、内固定术后神经功能恢复好,差异有统计学意义(P<0.05)。结论前路减压植骨融合内固定是治疗过伸性颈椎损伤首选手术方式,后路手术同样有效,是前路手术的有效补充。
Objective To evaluate the methods and efficacy of operative treatment of cervical hyperextensioninjury.Methods 83 cases of cervical hyperextension injury were retrospectively analyzed from January 2012 to June 2015.There were 63 males and 20 females,aged 25~78years,average 58.5years old.All patients were accompanied by spinal cord nerve lesions.According to Frankel classification,grade A accounted for 4cases,grade B accounted for 18 cases,grade C accounted for 32 cases and grade D accounted for 29 cases.All patients underwent surgical treatment.72 cases were treated with anterior disectomy or corpectomy,bone grafting andplate fixation.11 cases weretreated with posterior decompression with laminoplasty andlateral mass screws or pedicle screws fixation.Results All of them were followedup for 9to 18 months.All bone grafts fused,no failure of internal fixations was found.Preoperative and postoperative Frankel classifications and ASIA(American Spinal Injury Association)grades were compared between the two groups.The neural function improved significantly between the two groups after operation.The average of Frankel class increased by 1~2grade.ASIA score increased by(26.2±5.4)among anterior group(P=0.019),and increased by(15.2±6.1)in the posterior group(P=0.036).Cases underwentanterior approach had significantly better result in neural function than the posterior approach group(P<0.05).Conclusion It's preferred to choose anterior decompression with bone grafting and internal fixation as the surgical choice to treat cervical hyperextensioninjury.The posterior surgery also result in an effective outcome,which could be a supplement to the anterior surgery.
Objective To evaluate the methods and efficacy of operative treatment of cervical hyperextensioninjury.Methods 83 cases of cervical hyperextension injury were retrospectively analyzed from January 2012 to June 2015.There were 63 males and 20 females,aged 25~78years,average 58.5years old.All patients were accompanied by spinal cord nerve lesions.According to Frankel classification,grade A accounted for 4cases,grade B accounted for 18 cases,grade C accounted for 32 cases and grade D accounted for 29 cases.All patients underwent surgical treatment.72 cases were treated with anterior disectomy or corpectomy,bone grafting andplate fixation.11 cases weretreated with posterior decompression with laminoplasty andlateral mass screws or pedicle screws fixation.Results All of them were followedup for 9to 18 months.All bone grafts fused,no failure of internal fixations was found.Preoperative and postoperative Frankel classifications and ASIA(American Spinal Injury Association)grades were compared between the two groups.The neural function improved significantly between the two groups after operation.The average of Frankel class increased by 1~2grade.ASIA score increased by(26.2±5.4)among anterior group(P=0.019),and increased by(15.2±6.1)in the posterior group(P=0.036).Cases underwentanterior approach had significantly better result in neural function than the posterior approach group(P<0.05).Conclusion It's preferred to choose anterior decompression with bone grafting and internal fixation as the surgical choice to treat cervical hyperextensioninjury.The posterior surgery also result in an effective outcome,which could be a supplement to the anterior surgery.
引文
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[2]Spitzer WO,Skovron ML,Salmi LR,et al.Scientific monograph of the quebec task force on whiplash-associated disorder:redefining“whiplash”and its management[J].Spine,1995,20(Suppl 8):1-73.
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[4]戴力扬,蒋雷生,张家红,等.急性中央颈脊髓损伤临床表现的多样性与不典型性[J].骨与关节损伤杂志,2003,18(9):577-579.
[5]张亮,刘忠军,王静成,等.颈椎动力位MRI在无骨折脱位型脊髓损伤治疗方案选择中的价值[J].实用骨科杂志,2016,22(10):952-956.
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[8]Croft AC,Bagherian A,Mickelsen PK,et al.Comparing 2 whiplash grading systems to predict clinical outcomes[J].J Chiropr Med,2016,15(2):81-86.
[9]Stevenson CM,Dargan DP,Warnock J,et al.Traumatic central cord syndrome:neurological and functional outcome at 3years[J].Spinal Cord,2016,54(11):1010-1015.
[10]Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to sub-axial cervicalspine injuries:an evidence-based algorithmbased on the SLIC classification system[J].Spine,2007,32(1):2620-2629.
[11]赵彤,刘威.下颈椎损伤SLIC评分系统影像学表现的回顾性分析[J].中国骨与关节损伤杂志,2016,31(1):65-67.
[12]Joaquim AF,Patel AA,Vaccaro AR,et al.Cervical injuries scored according to the subaxial injury classification system:ananalysis of the literature[J].J Craniovert Jun Spine,2014,5(2):65-70.
[13]陈德纯,谭俊铭,王朝阳,等.下颈椎过伸性损伤的手术方式选择[J].中国骨与关节损伤杂志,2011,26(9):800-801.
[14]潘军伟,黄大耿,郝定均,等.寰枢椎失稳症的外科治疗研究进展[J].中国骨与关节损伤杂志,2014,29(3):308-309.
[15]Hierholzer C,Bühren V,Woltmann A.Operative timing and management of spinal injuries in multiply injured patients[J].Eur J Trauma Emerg Surg,2007,33(5):488-500.
[16]罗彬,冯浩,杨晓茂,等.颈椎管狭窄伴无骨折脱位型颈脊髓损伤颈椎不稳定因素分析[J].实用骨科杂志,2015,21(9):769-773;793.
[17]Shunzhi Yu,Fengning Li,Ning Yan,et al.Anterior fusion technique for multilevel cervical spondylotic myelopathy:a retrospective analysis of surgical outcome of patients with different number of levels fused[J].PLoS One,2014,9(3):e91329.
[18]Yifei Gu,Jueqian Shi,Peng Cao,et al.Clinical and imaging predictors of surgical outcome in multilevel cervical ossification of posterior longitudinal ligament:an analysis of 184 patients[J].PLoS One,2015,10(9):e0136042.
[19]Kode S,Gandhi AA,Fredericks DC,et al.Effect of multi-levelopen door laminoplasty and laminectomy on flexibility of thecervical spine:an experimental investigation[J].Spine(PhilaPa1976),2012,37(19):E1165-1170.
[20]Lee DH,Park SA,Kim NH,et al.Laminar closure afterclassic Hirabayashi open-door laminoplasty[J].Spine(Phila Pa 1976),2011,36(25):1634-1640.
[21]Jae Hyuk Choi,Jun Jae Shin,Tae Hong Kim,et al.Does intramedullary signal intensity on MRI affect the surgical outcomes of patients with ossification of posterior longitudinal ligament?[J].J Korean Neurosurg Soc,2014,56(2):121-129.
[22]白成瑞,费琦,李东,等.颈椎后路单开门术后神经功能和生活质量的关系探讨[J].实用骨科杂志,2016,22(10):865-869.
[23]Mahesh B,Upendra B,Vijay S,et al.Addressing stretch myelopathy in multilevel cervical kyphosis with posterior surgery using cervical pedicle screws[J].Asian Spine J,2016,10(6):1007-1017.
[24]刘勇,卲川强,陈长春,等.不同术式治疗下颈椎骨折脱位伴脊髓损伤[J].实用骨科杂志,2015,21(6):481-485.
[2]Spitzer WO,Skovron ML,Salmi LR,et al.Scientific monograph of the quebec task force on whiplash-associated disorder:redefining“whiplash”and its management[J].Spine,1995,20(Suppl 8):1-73.
[3]Schneider RC,Cherry G,Pantek H,et al.The syndrome of acute central cervical spinal cordinjury:with special reference to the mechanisms involved in hyperextension injury ofcervical spine[J].Neurosurg,1954,11(6):546-577.
[4]戴力扬,蒋雷生,张家红,等.急性中央颈脊髓损伤临床表现的多样性与不典型性[J].骨与关节损伤杂志,2003,18(9):577-579.
[5]张亮,刘忠军,王静成,等.颈椎动力位MRI在无骨折脱位型脊髓损伤治疗方案选择中的价值[J].实用骨科杂志,2016,22(10):952-956.
[6]Garcia T,Ravani B.A biomechanical evaluation of whiplash using a multi-body dynamic moder[J].J Biomech Eng,2003,125(2):254-265.
[7]Charlène Tournier,Martine Hours,Pierrette Charnay,et al.Five years after the accident,whiplash casualties still have poorer quality of life in the physical domain than other mildly injured casualties:analysis of the ESPARR cohort[J].BMC Public Health,2015,16(1):13.
[8]Croft AC,Bagherian A,Mickelsen PK,et al.Comparing 2 whiplash grading systems to predict clinical outcomes[J].J Chiropr Med,2016,15(2):81-86.
[9]Stevenson CM,Dargan DP,Warnock J,et al.Traumatic central cord syndrome:neurological and functional outcome at 3years[J].Spinal Cord,2016,54(11):1010-1015.
[10]Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to sub-axial cervicalspine injuries:an evidence-based algorithmbased on the SLIC classification system[J].Spine,2007,32(1):2620-2629.
[11]赵彤,刘威.下颈椎损伤SLIC评分系统影像学表现的回顾性分析[J].中国骨与关节损伤杂志,2016,31(1):65-67.
[12]Joaquim AF,Patel AA,Vaccaro AR,et al.Cervical injuries scored according to the subaxial injury classification system:ananalysis of the literature[J].J Craniovert Jun Spine,2014,5(2):65-70.
[13]陈德纯,谭俊铭,王朝阳,等.下颈椎过伸性损伤的手术方式选择[J].中国骨与关节损伤杂志,2011,26(9):800-801.
[14]潘军伟,黄大耿,郝定均,等.寰枢椎失稳症的外科治疗研究进展[J].中国骨与关节损伤杂志,2014,29(3):308-309.
[15]Hierholzer C,Bühren V,Woltmann A.Operative timing and management of spinal injuries in multiply injured patients[J].Eur J Trauma Emerg Surg,2007,33(5):488-500.
[16]罗彬,冯浩,杨晓茂,等.颈椎管狭窄伴无骨折脱位型颈脊髓损伤颈椎不稳定因素分析[J].实用骨科杂志,2015,21(9):769-773;793.
[17]Shunzhi Yu,Fengning Li,Ning Yan,et al.Anterior fusion technique for multilevel cervical spondylotic myelopathy:a retrospective analysis of surgical outcome of patients with different number of levels fused[J].PLoS One,2014,9(3):e91329.
[18]Yifei Gu,Jueqian Shi,Peng Cao,et al.Clinical and imaging predictors of surgical outcome in multilevel cervical ossification of posterior longitudinal ligament:an analysis of 184 patients[J].PLoS One,2015,10(9):e0136042.
[19]Kode S,Gandhi AA,Fredericks DC,et al.Effect of multi-levelopen door laminoplasty and laminectomy on flexibility of thecervical spine:an experimental investigation[J].Spine(PhilaPa1976),2012,37(19):E1165-1170.
[20]Lee DH,Park SA,Kim NH,et al.Laminar closure afterclassic Hirabayashi open-door laminoplasty[J].Spine(Phila Pa 1976),2011,36(25):1634-1640.
[21]Jae Hyuk Choi,Jun Jae Shin,Tae Hong Kim,et al.Does intramedullary signal intensity on MRI affect the surgical outcomes of patients with ossification of posterior longitudinal ligament?[J].J Korean Neurosurg Soc,2014,56(2):121-129.
[22]白成瑞,费琦,李东,等.颈椎后路单开门术后神经功能和生活质量的关系探讨[J].实用骨科杂志,2016,22(10):865-869.
[23]Mahesh B,Upendra B,Vijay S,et al.Addressing stretch myelopathy in multilevel cervical kyphosis with posterior surgery using cervical pedicle screws[J].Asian Spine J,2016,10(6):1007-1017.
[24]刘勇,卲川强,陈长春,等.不同术式治疗下颈椎骨折脱位伴脊髓损伤[J].实用骨科杂志,2015,21(6):481-485.