颈前路减压融合治疗无骨折脱位型颈脊髓损伤的临床疗效
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摘要
目的:探究颈前路减压融合用于治疗无骨折脱位型颈脊髓损伤(SCIWORA)的临床疗效。方法:回顾性分析2016年2月-2018年2月我院收治43例SCIWORA患者临床资料,术前检查确认病情后采用颈前路减压融合术治疗。比较患者神经功能改善情况,治疗前后日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)评分和生活质量评分,治疗后疗效和并发症以及随访结果。结果:患者随访结束前神经功能分级情况较治疗前明显改善(P<0.05);与治疗前比较,治疗后患者JOA评分、NDI评分和生活质量评分均显著改善(P<0.05);治疗后患者优13例,良15例,中11例,差4例,优良率为65.11%(28/43);术后3例出现吞咽困难患者,1例声音嘶哑患者,无内固定松动以及植骨愈合较差并发症出现; 21例患者在术后3个月复查时即发现植骨开始融合,36例患者在术后半年复查时可见植骨融合良好。结论:SCIWORA治疗采用颈前路减压融合,可以显著改善患者受损脊椎功能和神经功能以及患者生活质量,近期和远期疗效均较好。
Objective: To investigate the clinical efficacy of anterior cervical decompression and fusion for treatment of cervical spinal cord injury without radiographic abnormality( SCIWORA). Methods: The clinical data of 43 SCIWORA patients admitted to our hospital between February 2016 and February 2018 were retrospectively analyzed. The patients underwent anterior cervical decompression and fusion after preoperative examination for confirmed diagnosis. The improvements in neurological function,Japanese Orthopaedic Association( JOA) score,neck disability index( NDI) and quality of life in these patients were compared between baseline and post treatment. The treatment efficacy,complications,and follow-up findings were also recorded. Results: Up to the end of follow-up,the ratings of neurological function were significantly improved in these patients( P < 0.05). Compared with baseline,the JOA score,NDI and quality of life were significantly improved after treatment( P<0.05). The efficacy were excellent in 13 cases,good in 15,fair in 11,and poor in 4,yielding an overall rate of excellent and good efficacy being 65. 11%( 28/43). Three patients developed dysphagia,one developed hoarseness,but none experienced internal fixation loosening or poor fusion of the bone graft. During the follow-up,graft bone fusion was found to have started in 21 patients at three months after surgery,and were well developed in36 patients at six months after surgery. Conclusion: For SCIWORA,anterior cervical decompression and fusion may significantly improve injured spinal function,neurological function and quality of life in the patients,with satisfactory short-term and long-term outcomes.
Objective: To investigate the clinical efficacy of anterior cervical decompression and fusion for treatment of cervical spinal cord injury without radiographic abnormality( SCIWORA). Methods: The clinical data of 43 SCIWORA patients admitted to our hospital between February 2016 and February 2018 were retrospectively analyzed. The patients underwent anterior cervical decompression and fusion after preoperative examination for confirmed diagnosis. The improvements in neurological function,Japanese Orthopaedic Association( JOA) score,neck disability index( NDI) and quality of life in these patients were compared between baseline and post treatment. The treatment efficacy,complications,and follow-up findings were also recorded. Results: Up to the end of follow-up,the ratings of neurological function were significantly improved in these patients( P < 0.05). Compared with baseline,the JOA score,NDI and quality of life were significantly improved after treatment( P<0.05). The efficacy were excellent in 13 cases,good in 15,fair in 11,and poor in 4,yielding an overall rate of excellent and good efficacy being 65. 11%( 28/43). Three patients developed dysphagia,one developed hoarseness,but none experienced internal fixation loosening or poor fusion of the bone graft. During the follow-up,graft bone fusion was found to have started in 21 patients at three months after surgery,and were well developed in36 patients at six months after surgery. Conclusion: For SCIWORA,anterior cervical decompression and fusion may significantly improve injured spinal function,neurological function and quality of life in the patients,with satisfactory short-term and long-term outcomes.
引文
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[7]刘国铭,陈祖星,张昌茂.颈前路减压植骨融合带锁钛板内固定对治疗无骨折脱位型颈脊髓损伤临床效果分析[J].创伤与急诊电子杂志,2015,3(1):22-24.
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[10]郭琰,周方,田耘,等.下颈椎骨折脱位术式选择及疗效分析[J].中华创伤杂志,2015,31(3):232-235.
[11]戴斌,张兵,王金荣,等.颈椎前路减压融合内固定治疗成人无骨折脱位型颈脊髓损伤的疗效分析[J].现代医学,2017,45(2):210-214.
[12]杨耀宗,丁惠强.72例无骨折脱位型颈脊髓损伤的临床分析[J].宁夏医科大学学报,2014,36(11):1300-1302.
[13]丁琛,刘浩,龚全,等.人工颈椎间盘置换与颈前路融合术治疗脊髓型颈椎病3年随访结果报道[J].中国矫形外科杂志,2014,22(3):208-214.
[2]马迅,张鹏.无骨折脱位型颈脊髓损伤的研究进展[J].中华创伤杂志,2014,30(8):782-785.
[3]陈春,李江龙,刘继波,等.无骨折脱位型颈脊髓损伤患者27例疗效观察[J].重庆医学,2013,42(9):1046-1048.
[4]Kawaguchi Y,Nakano M,Yasuda T,et al.More Than 20Years Follow-up After En Bloc Cervical Laminoplasty[J].Spine,2016,41(20):1570-1579.
[5]Sundseth J,Kolstad F,Johnsen L G,et al.The Neck Disability Index(NDI)and its correlation with quality of life and mental health measures among patients with singlelevel cervical disc disease scheduled for surgery[J].Acta Neurochirurgica,2015,157(10):1807-1812.
[6]王小文,汪治臻,都定元,等.严重胸部钝性伤患者近期生活质量评价及相关影响因素分析[J].中华创伤杂志,2014,30(2):132-135.
[7]刘国铭,陈祖星,张昌茂.颈前路减压植骨融合带锁钛板内固定对治疗无骨折脱位型颈脊髓损伤临床效果分析[J].创伤与急诊电子杂志,2015,3(1):22-24.
[8]白新海,白睿.MRI在无骨折脱位型颈脊髓损伤诊疗中的应用[J].河北医学,2017,23(5):830-832.
[9]严力生,罗旭耀,鲍宏玮,等.ROI-C双嵌片自锁融合器在脊髓型颈椎病前路减压融合术中的应用[J].中华骨科杂志,2015,35(6):610-616.
[10]郭琰,周方,田耘,等.下颈椎骨折脱位术式选择及疗效分析[J].中华创伤杂志,2015,31(3):232-235.
[11]戴斌,张兵,王金荣,等.颈椎前路减压融合内固定治疗成人无骨折脱位型颈脊髓损伤的疗效分析[J].现代医学,2017,45(2):210-214.
[12]杨耀宗,丁惠强.72例无骨折脱位型颈脊髓损伤的临床分析[J].宁夏医科大学学报,2014,36(11):1300-1302.
[13]丁琛,刘浩,龚全,等.人工颈椎间盘置换与颈前路融合术治疗脊髓型颈椎病3年随访结果报道[J].中国矫形外科杂志,2014,22(3):208-214.