椎管储备间隙减少的过伸性颈髓损伤的手术疗效分析  

Surgical Treatment of Cervical Spinal Cord Extension Injury in the Decreased Storing Space of Spinal Canal

作　　者：张宏其[1] 肖勋刚[1] 龙文荣[1] 邓展生[1] 郭超峰[1] 胡建中[1] 陈静[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湖南长沙410008

出　　处：《医学临床研究》2006年第1期13-16,共4页Journal of Clinical Research

摘　　要：【目的】评价不同手术方法治疗椎管储备间隙减少的过伸性颈髓损伤的临床疗效。【方法】分别采用后路单开门扩大成形术（Ⅰ组，23例）以及后路减压、植骨、Vertex内固定术（Ⅱ组。29例）共治疗52例过伸性颈髓损伤患者。所有病例均经MRI提示为原有椎管储备间隙减少。对其术前、术后X线、CT、MRI等影像学资料及临床疗效进行回顾性分析。【结果】对所有病例进行随访，平均时间为26（3～49）个月，除了4例术后脊髓功能无改善外，其余神经功能均有不同程度的恢复,手术疗效判定采用日本骨科学会（JOA）评分标准。JOA评分改善率Ⅱ组明显高于Ⅰ组，且差异有显著性（P〈0．05），术后3个月Ⅱ组JOA评分改善率为51．4％，Ⅰ组为48．1％；术后6个月Ⅱ组JOA评分改善率为55．6％，Ⅰ组为50．5％;术后9个月以上Ⅱ组58．7％。Ⅰ组为51．9％。【结论】后路减压，Vertex固定，可恢复颈椎生理曲度，具有前后方均减压彻底，可重建颈椎稳定性，远期疗效好等优点。[Objective]To evaluate the clinical efficacy of surgical treatment of cervical spinal extension injury in the decreased storing space of spinal canal. [Methods]From August 2000 to February 2005, fifty two cases of extension injury of cervical spinal cord were treated surgically. All the cases were with the decreased storing space of spinal canal in MRI. Operative methods included： ① laminoplasty by exposing verterbral canal through posterior approach （Group Ⅰ ）. ② posterior decompression, autologous bonegraft, internal fixation with Vertex system （Group Ⅱ）.Their radiological data and clinical findings were retrospectively analyzed preoperatively and postoperatively.[Results]All patients were followed up for an average of 26（3～49）months, Their spinal cord functions evaluated by Japanese Orthopedic Association （JOA） Scoring improved in different degrees except 4 eases. The recovery rate of JOA scores in Group Ⅱ was better than in Group Ⅰ （P〈0.05）, 3 months postoperative recovery rate of JOA scores in Group Ⅱ was 51. 4%, that in Group Ⅰ was 48. 1%; 6 months postoperative recovery rate of JOA scores in Group Ⅱ was 55.6%, that in Group Ⅰ was 50.5%; 9 months postoperative recovery rate of JOA scores in Group Ⅱ was 58. 7%, that in Group I was 51.9%. [Conclusion]Patients with cervical spinal cord extension injury in the decreased storing space of spinal canal can be successfully treated by posterior decompression, Vertex fixation systems to recover the physiological curvature of cervical spine. The procedure allows anterior and posterior complete decompression, strengthens the spinal structure and gives an excellent clinical efficacy in the long run.

关 键 词：脊髓损伤/外科学 颈椎 椎管 

分 类 号：R651.2[医药卫生—外科学]