手术减压时限对脊髓急性不全损伤预后的影响(附67例报告)  

Effects of the time limit of surgical decompression on the prognosis of acute incomplete spinal cord injuries (a report of 67 cases)

作　　者：姚树智[1,2] 杨有庚[1] 苗旭漫[2] 左浩[2] 

机构地区：[1]吉林大学第二医院骨科,长春130041 [2]解放军208医院骨科中心

出　　处：《解放军医学杂志》2010年第3期282-284,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨伤后不同时间行手术减压对脊髓急性不全损伤患者神经功能恢复的影响。方法对2000年9月-2008年9月收治的67例颈椎及胸椎骨折脱位合并脊髓不全损伤患者进行回顾性分析,按受伤至手术时间分为3组:A组,伤后1d内(≤24h)行手术治疗(18例);B组,伤后1～3d(24～72h)行手术治疗(35例);C组,伤后3～14d(72～336h)行手术治疗(14例)。术后随访1～3年,根据美国脊柱脊髓损伤学会(ASIA)制定的感觉、运动评分标准和Frankel分级记录3组患者术前和术后的神经功能评分与分级情况,并进行统计学分析。结果术前3组ASIA评分及Frankel分级差异无统计学意义。术后3组患者感觉、运动评分及Frankel分级与术前比较均明显提高(P<0.01或P<0.05),术后感觉、运动评分A组明显高于B组、C组(P<0.01或P<0.05),B组明显高于C组(P<0.01),Frankel分级A组明显优于B组(P<0.05)和C组(P<0.01),B组和C组间比较无显著差异(P>0.05)。结论手术减压对脊髓不全损伤患者有确定的疗效,且手术越早神经功能恢复越好。Objective To investigate the effect of surgical decompression performed within different duration after the damage on nerve function recovery of the patients with acute incomplete spinal cord injury. Methods Data of 67 patients with lower cervical or upper thoracic vertebrae （C3-T12） fractures and dislocation complicated with spinal cord injury from Sep. 2000 to Sep. 2008 were retrospectively analyzed. Patients were divided into 3 groups according to the duration from trauma to surgical operation： Group A, received surgical treatment within 1d （≤24h） of trauma （n=18）; Group B, received surgical treatment 1-3 days （24-72h） after trauma （n=35）; and Group C, received surgical treatment 3-14 days （72-336h） after trauma （n=14）. All the patients were followed-up for 1-3 years, and the pre- and post-operative neurological scores and classification were recorded according to the scoring standard of sensory and motor scores promulgated by American Spinal Injury Association （ASIA） and Frankel＇s system, then they were analyzed and compared statistically. Results No statistically significant difference of AISA scores and Frankel classification existed among the 3 groups before surgical treatment. After surgical treatment, all the AISA sensory and motor scores and Frankel classification were significantly higher than those of the 3 groups before surgical treatment （P0.01 or P0.05）. The AISA sensory and motor scores were higher in group A than in group B and group C （P0.01 or P0.05）, and also in group B than in group C （P0.01）. The Frankel classification was higher in group A than in group B （P0.05） and group C （P0.01）, while no statistically significant difference existed between group B and group C （P0.05）. Conclusion Surgical decompression may have a definite therapeutic effect on the patients with acute incomplete spinal cord injury, and the earlier the procedure performed, the better the nerve function recovered.

关 键 词：脊髓损伤 减压术 外科 治疗结果 预后 

分 类 号：R651.210.53[医药卫生—外科学]