单开门椎管扩大术治疗无骨折脱位颈脊髓损伤的疗效评价  

Evaluation of therapeutic effects of expansive laminoplasty in the treatment of cervical spinal cord injuries without vertebrae fractures and dislocations

作　　者：刘建文[1] 尹锐锋[1] 顾夙[1] 李振武[1] 张长超 李中正 

机构地区：[1]南阳市中心医院骨科,河南南阳473009 [2]镇平县遮山卫生院 [3]南阳市肿瘤医院

出　　处：《中国骨伤》2005年第12期722-724,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过分析无骨折脱位颈脊髓损伤的临床特点及诊断方法,评价单开门椎管扩大术对其进行治疗的疗效.方法:40例无骨折脱位颈脊髓损伤患者通过X线平片测量颈椎椎管矢状径,32例存在发育性颈椎管狭窄.MR检查40例均见不同程度椎间盘突出、退行性颈椎管狭窄,16例脊髓前、后受压.本组40例均采用单开门椎管扩大术(中野式)治疗.结果:平均随访2～8年,后路较大范围减压未见不稳现象及再关门.神经功能按Frankel分级:30例恢复至E级,6例恢复至D级,2例恢复至C级,2例术前A级无恢复.上肢功能据颈脊髓神经根支配的肌肉功能分5级:Ⅳ级30例,Ⅲ级6例,Ⅱ级2例,Ⅰ级2例.38例患者能独立或通过辅助支具站立,不需帮助.结论:无骨折脱位颈脊髓损伤多合并颈椎管狭窄、多节段椎间盘突出,存在脊髓受压、水肿,应早期手术治疗.MRI对脊髓损伤的早期诊断、预后及正确制定治疗与康复计划有重要价值.单开门椎管扩大术减压彻底,持续地扩大颈椎管,未破坏椎间关节的稳定性,神经功能恢复满意,是值得推荐的优良术式之一.Objective： To evaluate therapeutic effects of expansive laminoplasty for this condition via analyzing the clinical characteristics and diagnostic methods of cervical spinal cord injuries without vertebrae fractures and dislocations. Methods：Of 40 patients with cervical spinal cord injuries without vertebrae fractures and dislocations,30 patients, diagnosed by X-ray examination, had a developmental cervical spinal canal stenosis. Cervical intervertebral disc herniation and degenerative stenosis were found in all of 40 patients by MRI, in which 16 patients had posterior and anterior compression of spinal cord. All the patients were treated with expansive laminoplasty of cervical spine. Results： After follow-up from 2 to 8 years, unstability of the vertebrae did not occurred after expansive decompression. Evaluated by Frankel grades, the nerve functions of 30 patients recovered to degree E, 6 to D, 2 to C and 2 still at A which were same as before operation. The upper extremity functions were divided into 5 degrees according to muscle functions which are controlled by nerve of cervical spinal cord. In this study, the upper extremity function reached to Ⅳ degree in 30 patients, Ⅲ in 6, Ⅱ in 2 and Ⅰ in 2.Thirty-eight patients were able to stand without any help or with brace. Conclusion： Cervical spinal cord injuries without vertebrae fractures and dislocations are often accompanied by cervical spinal canal stenosis and intervertebral disc herniation at multiple segments. If spinal cord is compressed and edema, operation should be performed timely. MRI is very helpful for medical doctors to diagnosis spinal cord injuries at early stage of wound, to select accurate treatment and rehabilitation programs and to judge its prognosi. The expansive laminoplasty of cervical spine has such advantages as complete decompression, continuous amplification of cervical spinal canal, without damage of stability of intervertebral joints and satisfactory recovery of nerve function, indicating that it is a kind of recomm

关 键 词：颈椎 脊髓损伤 椎管狭窄 椎间盘移位 骨科手术方法 

分 类 号：R681.550.5[医药卫生—骨科学] R651.15[医药卫生—外科学]