54例脊髓型颈椎病手术时机的临床分析  

A Clinical Study of Surgical Timing for 54 Cases of Cervical Spondylotic Myelopathy

作　　者：杨华[1] 邢维平[1] 尚显文[1] 宁旭[1] 张皓[1] 

机构地区：[1]贵阳医学院附属医院脊柱外科,贵州贵阳550001

出　　处：《中国现代医生》2010年第24期33-34,41,共3页China Modern Doctor

摘　　要：目的准确判断脊髓型颈椎病的病情轻重,及时施行手术治疗,避免病程延长加重脊髓损伤。方法收集我院2003年3月～2009年6月经手术治疗并获随访的脊髓型颈椎病54例,按病程分为A、B两组,A组术前病程≤6月,共25例,B组术前病程>6个月,共29例,比较两组病例术后平均改善率以及两组病例中脊髓发生严重损伤的发生率。所有病例均行颈椎常规X线片及MRI检查。结果病程≤6个月的患者术后平均改善率明显高于病程>6个月的患者,且差异有统计学意义(P<0.01);病程≤6个月的患者术前脊髓严重损伤发生率低于病程>6个月的患者,但差异无统计学意义(P>0.05)。脊髓型颈椎病患者MRI均有不同程度的脊髓压迫表现。结论脊髓型颈椎病病程延长将影响手术疗效,但病程较短者脊髓仍然可能发生严重损伤而影响手术疗效,在脊髓发生轻中度损伤时施行手术治疗可以避免脊髓损伤加重。MRI的脊髓压迫表现是决定手术的重要参考。Objective To explore an accurate judgment over and good surgical timing for cervical spondylotic myelopathy （SCM） to avoid delay-induced spine cord injury. Methods Fifty-four patients receiving surgery and follow-up visits between March 2003 and June 2009 were divided into Group A and B. 25 Patients in Group A are those whose pre-surgery courses of disease were ？ 6 months while 29 patients in Group B are those with pre-surgery courses of diseases〉6 months. Average post-surgical improvement rate and the incidence rate of severe spinal cord injury were compared between the two groups. All patients received routine X-ray and MRI exams. Results The average post-surgical improvement rate was higher in Group A than in Group B, and the difference was statistically significant（P〈0.01 ）. The incidence rate of severe spinal cord injury was lower in Group A than Group B, but the difference was statistically insignificant （P〈0.05）. MRI exams showed SCM patients all suffered from spinal cord compression of different degrees. Conclusion Prolonged course of disease had a negative impact on the surgical effect from SCM patients. Severe spinal cord injury is still likely for patients with short courses of disease and thus reduces the surgical effect. Timely surgical treatment for mild and intermediate injury of spinal cord can prevent the worsening of spinal cord injury. MRI manifestation of spinal cord compression is an important reference for surgical timing.

关 键 词：病程 脊髓压迫症 影像学表现 手术时机 

分 类 号：R681.55[医药卫生—骨科学]