无骨折脱位型颈髓损伤保守与后路手术治疗的比较
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摘要
[目的]比较保守与后路手术治疗无骨折脱位型颈髓损伤患者的临床效果。[方法] 2014～2017年本院收治56例入院诊断为无骨折脱位型颈髓损伤患者,男39例,女17例,年龄40～69岁,平均(52.37±11.62)岁。19例行保守治疗,37例行后路椎管开门减压手术,包括21例单纯减压,16例减压侧块螺钉固定融合术。采用脊髓损害Frankel分级及JOA评分对比分析判定脊髓功能恢复情况。[结果] 37例手术治疗患者均顺利手术,除单纯减压术1例切口浅表感染,经清创愈合外,未发生严重并发症。56例随访12～24个月,平均(18.53±6.35)个月。入院时两组患者Frankel评级的差异无统计学意义(P>0.05),末次随访时手术组Frankel评级平均提高1.41级,保守组平均提高0.37级,两组差异有统计学意义(P<0.05)。入院时两组患者的JOA评分差异无统计学意义(P>0.05),末次随访时两组JOA评分均较入院时显著增加,差异有统计学意义,但末次随访时手术组JOA评分显著高于保守组,差异有统计学意义(P<0.05)。[结论]对于无骨折脱位型颈髓损伤,实施颈椎后路手术减压或和内固定术可促进无骨折脱位型不完全性颈髓损伤神经功能恢复,临床效果优于保守治疗。
[Objective] To compare the clinical outcomes of non-operative treatment versus surgical posterior decompression for cervical spinal cord injury without fracture and dislocation. [Methods] From 2014 to 2017, 56 patients, including 39 males and 17 females aged from 40 to 68 years with an average of(52.37±11.62) years, were treated in our department for cervical spinal cord injury without fracture and dislocation. Of them, 19 patients received non-operative treatment, while the remaining 37 patients underwent surgical posterior decompression, including posterior open-door laminoplasty only in 21 patients, and open-door laminoplasty combined with instrumented fusion by lateral mass screw fixation in 16 patients. The Frankel grading for spinal cord injury and Japanese Orthopaedic Association(JOA) score were used for comparing between the two groups. [Results] All the 37 patients in the operative group had surgeries performed smoothly. Except one who had superficial incision infection secondary to posterior decompression only, which cured by local debridement, no serious complication happened in anyone of them. All the 56 patients were followed up for 12 to 24 months with an average of(18.53±6.35) months. Although no a significant difference was noticed between the two groups in Frankel grades at admission(P>0.05), the operative group with 1.41 upgraded Frankel grades was significantly superior to the non-operative group with 0.37 upgraded Frankel grades at the latest follow up(P<0.05). Even though no a significant difference was proved between the two groups at admission in JOA scores(P>0.05), which significantly increased in both groups over time(P<0.05), the operative group was marked significantly higher JOA scores than the non-operative group at the latest follow up(P<0.05). [Conclusion] Surgical posterior decompression, including open-door laminoplasty only or combined with instrumented fusion is superior to the non-operative treatment for cervical spinal cord injury without fracture and dislocation in neurological function recovery.
[Objective] To compare the clinical outcomes of non-operative treatment versus surgical posterior decompression for cervical spinal cord injury without fracture and dislocation. [Methods] From 2014 to 2017, 56 patients, including 39 males and 17 females aged from 40 to 68 years with an average of(52.37±11.62) years, were treated in our department for cervical spinal cord injury without fracture and dislocation. Of them, 19 patients received non-operative treatment, while the remaining 37 patients underwent surgical posterior decompression, including posterior open-door laminoplasty only in 21 patients, and open-door laminoplasty combined with instrumented fusion by lateral mass screw fixation in 16 patients. The Frankel grading for spinal cord injury and Japanese Orthopaedic Association(JOA) score were used for comparing between the two groups. [Results] All the 37 patients in the operative group had surgeries performed smoothly. Except one who had superficial incision infection secondary to posterior decompression only, which cured by local debridement, no serious complication happened in anyone of them. All the 56 patients were followed up for 12 to 24 months with an average of(18.53±6.35) months. Although no a significant difference was noticed between the two groups in Frankel grades at admission(P>0.05), the operative group with 1.41 upgraded Frankel grades was significantly superior to the non-operative group with 0.37 upgraded Frankel grades at the latest follow up(P<0.05). Even though no a significant difference was proved between the two groups at admission in JOA scores(P>0.05), which significantly increased in both groups over time(P<0.05), the operative group was marked significantly higher JOA scores than the non-operative group at the latest follow up(P<0.05). [Conclusion] Surgical posterior decompression, including open-door laminoplasty only or combined with instrumented fusion is superior to the non-operative treatment for cervical spinal cord injury without fracture and dislocation in neurological function recovery.
引文
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[2]雷宇,于淼,刘晓光,等.脊髓型颈椎病患者脊髓MRI T2WI高信号的危险因素[J].中国脊柱脊髓杂志,2016,26(7):585-590.
[3]孙宇,蔡钦林,王少波,等.无骨折脱位型颈脊髓损伤的外科治疗[J].中国脊柱脊髓杂志,2001,11(3):139-141.
[4]陈永基,蓝健君.无骨折脱位型颈髓损伤的CT、MR研究[J].国际医药卫生导报,2006,12(9):19-20.
[5]刘彩霞.3.0T磁共振扩散张量成像在正常颈髓及脊髓型颈椎病的临床应用研究[D].广州:南方医科大学,2012.
[6]党耕町,孙宇,刘忠军.无骨折脱位型颈脊髓损伤及外科治疗[J].中国脊柱脊髓杂志,2003,13(10):581-582.
[7]祁文,唐晓菊,刘汝专,等.手术治疗急性无骨折脱位型颈髓损伤的回顾性分析[J].中国矫形外科杂志,2011,19(18):1507-1509.