外伤致脊髓型颈椎病患者脊髓损伤的手术疗效分析  

Surgical effects on cervical spondylotic myelopathy complicated with trauma

作　　者：王冰[1] 林欣[1] 崔维[1] 李家谋[1] 韩伟峰[1] 王磊[1] 孟桦[1] 

机构地区：[1]首都医科大学附属北京天坛医院骨科,100050

出　　处：《中华创伤骨科杂志》2009年第3期236-238,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的观察应用显微外科技术治疗外伤致脊髓型颈椎病患者脊髓损伤的疗效，探讨对影像学重度压迫的脊髓型颈椎病预防性手术的必要性。方法2003年2月至2006年3月，对23例因外伤致脊髓型颈椎病患者脊髓损伤采用颈前路、后路及前后联合人路手术治疗，术前及术后1-2年采用JOA脊髓功能评分和影像学评估，评价手术效果。结果20例患者术后症状即刻改善；3例于术后3个月内症状改善，其中2例术后神经症状短时间加重，1例于术后1周后恢复，另1例术后3周恢复（但其左上肢肌力未达到术前水平）。按JOA17分法评分，术前平均（6．67±2．35）分，术后平均（13．86±1．11）分，术前与术后12个月JOA评分差异有统计学意义（t=-15．100，P〈0．05），平均改善率为69．16％。影像学证实减压充分，椎体间植骨均愈合良好，23例患者均较满意。结论脊髓型颈椎病患者遭受外力致脊髓损伤后应尽早手术，可获得良好效果。椎管受压面积超过50％以上，尽管临床症状体征表现较轻，亦应尽早行预防性手术治疗，以防止受外力刺激突然加重导致瘫痪的严重后果。Objective To analyze the clinical results of microsurgery for cervical spondylotic myelopathy （CSM） complicated with trauma by an anterior or posterior approach. Methods From February 2003 to March 2006, 23 patients with traumatic CSM were subjected to mierosurgery through an anterior, posterior or combined approach. They were followed up for 1 to 2 years. Their spinal functions and the surgical effects were evaluated by pre ＆ post-operative JOA scores and cervical images. Results Twenty patients got improved instantly after operation. Three patients were improved in 3 months. The neural symptoms became a little worse after surgery in 2 patients, one of whom recovered in a week and the other recovered in 3 weeks but did not restore the muscle strength of the left upper limb. According to the JOA scores, the average rate of improvement was 69. 16%. The images indicated that their spinal cord was decompressed completely and all the intervertebral grafts got fine union. Conclusions Patients with traumatic CSM should be given surgery as soon as possible to secure fine effects. When more than 50% of the vertebral canal is compressed, prophylactic surgery should be taken to prevent palsy, even though the clinical symptoms and physical signs are mild.

关 键 词：颈椎病 外伤 显微外科手术 

分 类 号：R686[医药卫生—骨科学]