颈椎颈髓损伤后外科治疗时间对预后的影响  

The relationship between the prognosis and surgical intervention time in the patients with cervical spinal cord injury

作　　者：王岩松[1] 姚猛[2] 刘庆鹏[2] 董大明[2] 张旗涛[2] 陈立民[2] 姜永庆[2] 孙崇毅[2] 吉光荣[2] 

机构地区：[1]哈尔滨医科大学附属二院脊柱外科中心150086黑龙江省哈尔滨市 [2]哈尔滨医科大学附属二院脊柱外科中心

出　　处：《中国脊柱脊髓杂志》2004年第11期659-662,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:前瞻性比较颈椎颈髓损伤患者在3d内与10～14d内进行外科干预后神经功能恢复的情况.方法:32名急性颈椎颈髓损伤的患者根据入选标准随机分为早期手术组(3d内手术)和择期手术组(10～14d内手术).分别记录患者术前和术后2年的Frankel分级和感觉、运动评分(依据美国脊髓损伤学会的标准).结果:与术前相比,两组患者术后的感觉、运动评分均有明显改善(P＜0.01),Frankel分级的改善程度早期手术组明显优于择期手术组(P＜0.01).结论:急性颈椎颈髓损伤在3d内进行手术治疗者神经功能恢复的结果优于10～14d内行手术者.因此,颈椎颈髓损伤后应尽可能地早期进行外科干预.Objective:To investigate prospectively changes in neurologic outcome associated with surgery within 3 days of injury versus within 10 to 14 days after the acute cervical spinal cord injury.Method:32 patients with acute cervical spinal cord injury were randomly divided into two groups according to inclusive criteria.The patients in early surgical group had surgical intervention within 3 days after injury.The patients in delayed surgical group underwent conservative treament for 10 to 14 days before undergoing surgical procedures.The neurologic status were recorded preoperatively and at the time of two years postoperatively by Frankel grade,American Spinal Injury Association motor index score and sensation index.The Frankel grade was recorded as levels 1 to 5,corresponding to grades A to E,respectively.Result:The change in the motor and sentation scores from preoperative assessment to postoperative assessment was statistically significant different in the two groups of patients who underwent early surgery and delayed surgery.The change in the Frankel grade from the preoperative level to the postoperative level were also statistically significant different in the two groups.Especially,all of the patients who underwent early surgery showed significantly better(P<0.01) Frankel grade,motor and sentation scores compared with the patients who underwent delayed surgery.Conclusion:Surgery within 3 days of injury in patients sustaining acute cervical spinal cord injuries may improve neurologic recovery compared with surgery performed in 10 to 14 days.

关 键 词：颈椎 脊髓损伤 手术时间 神经功能 预后 

分 类 号：R683.2[医药卫生—骨科学]