颈椎间盘突出致脊髓半切综合征的临床诊治  

Diagnosis and treatment for Brown-Sequard syndrome caused by cervical disc hernia

作　　者：杨海松[1] 陈德玉[1] 卢旭华[1] 史建刚[1] 严望军[1] 黄平[1] 陈宇[1] 

机构地区：[1]第二军医大学附属长征医院,上海200003

出　　处：《脊柱外科杂志》2009年第3期129-131,145,共4页Journal of Spinal Surgery

摘　　要：目的探讨颈椎间盘突出导致脊髓半切综合征的临床特点、诊断及治疗方法的选择。方法回顾性分析2002年1月～2008年1月由颈椎间盘突出导致的脊髓半切综合征患者15例,其中男9例,女6例;平均年龄为50.8岁。临床共同特点为病变平面以下同侧肢体运动功能的明显减弱或消失,同时伴有对侧肢体痛温觉功能的明显减弱甚至消失。术前均行MRI检查,证实了突出的椎间盘压迫脊髓一侧半。所有患者均行颈前路减压椎间植骨融合内固定术。采用日本矫形外科学会(JOA)制定的评分系统为疗效评价标准,分别记录术前、术后JOA分值,并计算JOA改善率。结果14例患者行前路经椎间隙减压,1例行椎体次全切除减压,所有患者术后肌力明显改善,痛温觉恢复良好。JOA分值由术前的平均9.2分提高到术后13.7分;改善率为45%～97%,平均81%。术后平均随访18个月,无神经症状加重者,未出现并发症。结论突出的颈椎间盘可压迫脊髓一侧半,临床表现为脊髓半切综合征的特点。依据临床特征和MRI可快速明确诊断,早期行颈前路彻底减压疗效良好。Objective To discuss the clinical characteristics, diagnosis and treatment for Brown-Sequard syndrome caused by cervical disc hernia. Methods From January 2002 to January 2008, 15 patients （9 males, 6 females） with the mean age of 50.8 years old diagnosed of cervical disc hernia associated with Brown-Sequard syndrome were examined. The common clinical manifestation was ipsilateral loss （weakness） of motor function combined with loss （diminished） of sensation to pain and temperature on the contralateral side. Preoperative MRI confirmed the compression on one side of the spinal cord was caused by the herniated cervical disc. Anterior decompression with fusion was performed on all the patients. The criteria of the Japanese orthopaedic association （JOA） score system was used to estimate the functional ability. Preoperative and postoperative JOA scores were recorded respectively and meanwhile the JOA recovery ratio was also calculated. Results Anterior decompression via intervertebal space was performed on 14 patients and SUbtotal excision was performed on i patient. The patients regained their strength and sensation to pain and temperature rapidly. Postoperative JOA score was 13：7 in average while the mean preoperative JOA score was only 9.2, and the recovery ratio ranged from 45% , 97% with an average of 81%. Follow up（ 18 months on average） for each patient showed no progress of neurological symptoms and no compllcations, Conclusion ： Brown-Sequard syndrome can be caused by a herniated cervical disc compressing one half of the spinal cord. A successful recovery can be obtained when a rapid diagnosis was made via clinical features and MRI followed by a complete anterior decompression.

关 键 词：颈椎 椎间盘移位 脊髓损伤 

分 类 号：R681.531[医药卫生—骨科学]