过伸性颈脊髓损伤外科干预时机及早期手术适应证  

The indications and opportunity of surgical intervention for hyperextension injuries of cervical spinal cord

作　　者：方加虎[1] 贾连顺[1] 周许辉[1] 陈雄生[1] 

机构地区：[1]第二军医大学长征医院骨科六病区,上海200003

出　　处：《临床骨科杂志》2007年第4期289-292,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨过伸性颈脊髓损伤的外科干预时机及早期手术的适应证选择。方法107例过伸性颈脊髓损伤,根据治疗方式和接受手术时间的不同分成4组：非手术治疗组（21例）、1-7 d手术组（37例）、8-14 d手术组（37例）、14 d以后手术组（9例）,比较4组间治疗前后的ASIA评分改变。结果3例死亡,104例获得12-28个月随访,脊髓神经功能按ASIA运动评分,平均增长值：手术组均高于非手术治疗组（P〈0.05）,1-7 d手术组（41.85±13.91）高于8-14 d手术组（35.01±13.01）（P〈0.05）,8-14 d手术组（35.01±13.01）高于14 d以后手术组（26.91±10.05）（P〈0.05）。结论过伸性颈脊髓损伤的手术治疗应在伤后7 d内进行,尽早手术减压是最大限度恢复神经功能的关键。凡MR I提示颈脊髓损伤、间盘损伤、突出者,早期手术可避免因颈椎不稳造成神经的继发性损伤,保证其远期疗效。Objective To explore the opportunity of surgical intervention and early surgical indication for hyperextension injuries of cervical spinal cord. Methods 107 cases of hyperextension injuries of cervical spinal cord were treated, and 104 cases had been followed up and analyzed retrospectively. According to the ways of treatment and the time before operation, there were 4 groups ： non-operation , operated in 0 - 7 days, operated in 8 - 14 days, operated after 14 days. Their therapeutic effects were compared respectively. Results 3 cases died, and 104 cases were followed up for 12 -28 months. Pre-operative and post-operative ASIA motor score were compared between the 4 groups. The operation patients had significantly better outcome in neural function than the non-operation patients （ P 〈 0. 05 ）. Patients operated in 1 -7 days（41.85 ± 13. 91 ） and patients operated in 8 - 14 days（35.01±13.01 ）had significantly better outcome in neural function than patients operated after 14 days （26. 91 ± 10. 05, P 〈 0. 05 ）, and patients operated in 8 - 14 days had slightly better outcome in neural function than patients operated after 14 days. Conclusions The operating indications for the patients with hyperextension injuries of cervical spinal cord are changed MRI signals of spinal cord, impaired cervical intervertebral disc in MRI. Operation is done to patients with cervical spinal cord hy- perextension injuries in 7 days after injuries is the best choice for spinal surgeons. Early operation is the key to save the function of spinal nerves closing to ischemic necrosis and has a good long term efficacy.

关 键 词：颈椎 脊髓损伤/治疗 过伸性损伤 早期手术 

分 类 号：R683.2[医药卫生—骨科学] R651.21[医药卫生—外科学]