脊柱创伤合并脊髓损伤的手术治疗及疗效评估
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摘要
目的 :观察与评估脊柱创伤合并脊髓损伤(SCI)的手术方法及疗效。方法 :随机选取本院2016年4月～2018年4月收治的32例脊柱创伤合并SCI患者作为研究对象,32例患者均采取椎体次全切除术治疗,术后进行3个月随访评估。术后对所有患者手术时间、术中出血量进行统计分析,对术前和术后3个月患者的椎体前缘、后缘压缩高进行比较,并采用视觉模拟评分法(VAS)对术前与术后3个月的疼痛程度进行比较,同时根据疗效评估标准比较术前与术后3个月患者的Harris评分及Barthel指数自主生活能力评分。结果 :该研究中32例患者手术时间统计结果为(171.5±47.7)min;术中出血量统计结果为(451.4±87.3)mL;术前患者椎体前缘及椎体后缘平均压缩高度分别为(41.14±12.7mm、27.05±9.34mm),术后3个月随访时两者平均压缩高度分别为(4.27±1.95mm、3.16±1.47mm);术前患者VAS评分为(8.73±2.47)分,术后3个月随访时为(2.14±1.45)分;术前患者Harris评分为(4.74±3.02)分,术后3个月随访评分为(57.14±3.42)分;32例患者术后3个月进食、穿衣、行走等自主生活能力评分均显著提高;且上述结果均具有统计学意义。结论 :脊柱创伤合并SCI患者采用椎体次全切除术治疗效果较好,术后患者椎体平均压缩高度明显降低,疼痛缓解明显,且术后患者自主生活能力恢复显著。同时为了确保手术最终疗效,我们根据患者损伤类型及程度选择合理的手术入路其实是治疗的关键。
Objective To observe and evaluate the surgical method and effect of spinal trauma combined with spinal cord injury(SCI). Methods 32 cases of SCI patients with spinal trauma admitted by our hospital from April 2016 to April 2018 were randomly selected as the study subjects, 32 patients were treated with vertebral subtotal resection and were followed up for 3 months. Postoperative statistical analysis was conducted on all patients' operative time and intraoperative blood loss, and comparison was made on the compression height of the anterior and posterior margins of vertebral body between the preoperative and postoperative 3 months.Visual analogue scale(VAS) was used to compare the pain degree before surgery with that of 3 months after surgery. Meanwhile,Harris score and Barthel index score of patients before surgery and 3 months after surgery were compared according to the efficacy evaluation criteria. Results The operative time of 32 patients in this study was calculated at(171.5±47.7) min. The statistical re-sult of intraoperative blood loss was(451.4±87.3) ml. The mean compression height of the anterior and posterior margins of the vertebral body respectively were(41.14±12.7 mm and 27.05±9.34 mm) and The mean compressive height of the two was(4.27±1.95 mm and 3.16±1.47 mm), respectively, at 3 months postoperative follow-up. The VAS score of preoperative patients was(8.73±2.47), and(2.14±1.45) at 3 months of follow-up. Preoperative Harris score was(4.74±3.02), and postoperative follow-up score was(57.14±3.42). In 32 patients, the scores of independent living ability, such as eating, dressing and walking, were significantly improved 3 months after surgery. The above results were statistically significant. Conclusion Patients with spinal trauma combined with SCI had better therapeutic effect with vertebral subtotal resection. The average vertebral compression height of postoperative patients was significantly reduced, pain relief was obvious, and patients' ability to live independently recovered significantly after surgery. At the same time, in order to ensure the final curative effect of the surgery, we choose a reasonable surgical approach according to the type and degree of injury of the patients, which is actually the key to treatment.
Objective To observe and evaluate the surgical method and effect of spinal trauma combined with spinal cord injury(SCI). Methods 32 cases of SCI patients with spinal trauma admitted by our hospital from April 2016 to April 2018 were randomly selected as the study subjects, 32 patients were treated with vertebral subtotal resection and were followed up for 3 months. Postoperative statistical analysis was conducted on all patients' operative time and intraoperative blood loss, and comparison was made on the compression height of the anterior and posterior margins of vertebral body between the preoperative and postoperative 3 months.Visual analogue scale(VAS) was used to compare the pain degree before surgery with that of 3 months after surgery. Meanwhile,Harris score and Barthel index score of patients before surgery and 3 months after surgery were compared according to the efficacy evaluation criteria. Results The operative time of 32 patients in this study was calculated at(171.5±47.7) min. The statistical re-sult of intraoperative blood loss was(451.4±87.3) ml. The mean compression height of the anterior and posterior margins of the vertebral body respectively were(41.14±12.7 mm and 27.05±9.34 mm) and The mean compressive height of the two was(4.27±1.95 mm and 3.16±1.47 mm), respectively, at 3 months postoperative follow-up. The VAS score of preoperative patients was(8.73±2.47), and(2.14±1.45) at 3 months of follow-up. Preoperative Harris score was(4.74±3.02), and postoperative follow-up score was(57.14±3.42). In 32 patients, the scores of independent living ability, such as eating, dressing and walking, were significantly improved 3 months after surgery. The above results were statistically significant. Conclusion Patients with spinal trauma combined with SCI had better therapeutic effect with vertebral subtotal resection. The average vertebral compression height of postoperative patients was significantly reduced, pain relief was obvious, and patients' ability to live independently recovered significantly after surgery. At the same time, in order to ensure the final curative effect of the surgery, we choose a reasonable surgical approach according to the type and degree of injury of the patients, which is actually the key to treatment.
引文
[1]屈平义.脊柱创伤合并脊髓损伤手术治疗及预后效果探讨[J].当代医学, 2016,(4):94-94.
[2]Jiang WY, Ma WH, Gu YJ, et al.[French door segmented laminectomy decompression for severe cervical ossification of posterior longitudinal ligament complicated with spinal cord injury[J]. Zhongguo Gu Shang,2017, 30(9):844-848.
[3]曾周景,叶建华,唐桂阳,等.通用型脊柱内固定系统-Ⅳ后路椎弓根钉固定治疗胸腰椎骨折[J].中华创伤骨科杂志, 2009, 11(4):384-385.
[4]何正兵.脊柱创伤合并脊髓损伤的手术治疗方法及预后效果观察[J].中外医学研究, 2017,(28):145-147.
[5]Yang F, Tan MS, Yi P, et al.[Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy][J]. Zhongguo Gu Shang, 2018, 31(1):30-36.
[6]Xu ZW, Lun DX. Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture[J].J Orthop Surg Res, 2014, 9:77.
[7]宋玉铭,冯文涛.脊柱创伤合并脊髓损伤手术治疗及预后效果观察[J].中外医学研究, 2017,(32):173-174.
[8]杜杰,廖彦生,张仲凡.脊柱创伤合并脊髓损伤患者的治疗效果[J].中国实用医药, 2016,(14):75-76.
[9]何小勇.颈椎创伤合并脊髓损伤手术治疗的预后和影响因素[J].浙江创伤外科, 2015,(04):644-646.
[10]张群,王冰,徐建,等.探究脊柱创伤合并脊髓损伤的治疗效果观察[J].中国医学工程, 2015,(10):66+68.
[11]王文君.脊柱创伤合并脊髓损伤的38例临床治疗[J].世界最新医学信息文摘(电子版), 2013,(19):43-43, 22.
[12] Nagata K, Tanaka Y, Kanai H, et al. Acute complete paraplegia of8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord[J]. Eur Spine J,2017, 26(5):1432-1435.
[13]白金柱,洪毅,张军卫,等.中上胸椎骨折合并脊髓损伤的临床特点和治疗策略[J].中国矫形外科杂志, 2011, 19(14):1041-1044.
[2]Jiang WY, Ma WH, Gu YJ, et al.[French door segmented laminectomy decompression for severe cervical ossification of posterior longitudinal ligament complicated with spinal cord injury[J]. Zhongguo Gu Shang,2017, 30(9):844-848.
[3]曾周景,叶建华,唐桂阳,等.通用型脊柱内固定系统-Ⅳ后路椎弓根钉固定治疗胸腰椎骨折[J].中华创伤骨科杂志, 2009, 11(4):384-385.
[4]何正兵.脊柱创伤合并脊髓损伤的手术治疗方法及预后效果观察[J].中外医学研究, 2017,(28):145-147.
[5]Yang F, Tan MS, Yi P, et al.[Clinical study on spinal cord decompression combined with traditional Chinese medicine for the treatment of cervical spondylotic myelopathy][J]. Zhongguo Gu Shang, 2018, 31(1):30-36.
[6]Xu ZW, Lun DX. Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture[J].J Orthop Surg Res, 2014, 9:77.
[7]宋玉铭,冯文涛.脊柱创伤合并脊髓损伤手术治疗及预后效果观察[J].中外医学研究, 2017,(32):173-174.
[8]杜杰,廖彦生,张仲凡.脊柱创伤合并脊髓损伤患者的治疗效果[J].中国实用医药, 2016,(14):75-76.
[9]何小勇.颈椎创伤合并脊髓损伤手术治疗的预后和影响因素[J].浙江创伤外科, 2015,(04):644-646.
[10]张群,王冰,徐建,等.探究脊柱创伤合并脊髓损伤的治疗效果观察[J].中国医学工程, 2015,(10):66+68.
[11]王文君.脊柱创伤合并脊髓损伤的38例临床治疗[J].世界最新医学信息文摘(电子版), 2013,(19):43-43, 22.
[12] Nagata K, Tanaka Y, Kanai H, et al. Acute complete paraplegia of8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord[J]. Eur Spine J,2017, 26(5):1432-1435.
[13]白金柱,洪毅,张军卫,等.中上胸椎骨折合并脊髓损伤的临床特点和治疗策略[J].中国矫形外科杂志, 2011, 19(14):1041-1044.