脊髓损伤中央综合征分期手术的疗效分析  

Therapeutic effect of staged surgery for central cord syndrome of the cervical spine

作　　者：刘碧峰[1] 赵杰[1] 康一凡[1] 马辉[1] 张丽恒[1] 

机构地区：[1]上海市长海医院骨科,上海200433

出　　处：《南方医科大学学报》2010年第8期1956-1958,共3页Journal of Southern Medical University

摘　　要：目的回顾性分析脊髓损伤中央综合征（CCS）患者分期手术治疗方法并评估分期手术的疗效。方法根据年龄将分期手术治疗的脊髓损伤中央综合征患者36例（年龄：5079岁,平均56.9岁）分为：A组〈65岁和B组≥65岁;根据二期手术椎板减压的范围分为：1组〈4个椎板（A1,B1）和2组≥4个椎板（A2,B2）。一期手术选择颈前路减压、植骨、内固定治疗;密切随访1年后根据神经功能恢复以及影像学表现等情况,有必要手术者选择二期后路椎板减压术（〈4个椎板或≥4个椎板）,必要时加后路内固定术。采用美国脊髓损伤委员会运动功能评分（AMS）系统评分,比较手术前、一期手术后1年、二期手术后末次随访脊髓功能。结果 36例二期术后随访632月,平均18.4月。一期手术后AMS评分：A组：75.8±14.6;B组：73.2±13.1;A1组：78.5±10.2;A2组：76.8±9.5;B1组：72.2±12.6;B2组：77.4±18.3。二期手术后AMS评分：A组：90.7±10.5;B组：89.5±12.4;A1组：91.3±13.2;A2组：90.7±14.8;B1组：88.5±11.2;B2组：92.4±13.6。A组和B组之间没有显著性差异,P〉0.05;A1和B1与A2和B2组之间也没有显著性差异,P〉0.05。A组一期手术后AMS为75.8±14.6,二期手术后AMS为90.7±10.5;B组一期手术后AMS为73.2±13.1,二期手术后AMS为89.5±12.4;比较A组和B组一期手术和二期手术后AMS评分有显著性差异,P〈0.05。结论分期手术治疗脊髓损伤中央综合征明显改善患者的AMS,分期手术是脊髓损伤中央综合征患者很好的治疗方法;脊髓损伤中央综合征患者手术治疗效果与年龄和椎板减压范围没有显著联系,手术减压彻底后可以达到良好的疗效。Objective To evaluate the effect of staged surgical treatment on central cord syndrome of the cervical spine. Methods A retrospective analysis was conducted in 36 cases of central cord syndrome of the cervical spine treated with staged surgery. The patients （aged 50 to 79 years, mean 56.9 years） were divided into group A （50 to 64 years old, n=20） and group B （above 65 years old, n=16）, and each group was further divided into 2 subgroups according to the range of decompression in the second stage, namely A1, B1 and A2, B2. ASIA motor score （AMS） was analyzed before the first-stage surgery, before the second-stage surgery and at the last follow-up after the second-stage surgery. Results All the surgeries were performed successfully. The patients were followed up for 12 to 32 months （mean 18.4 months） after the second-stage surgery. After the first-stage surgery, the AMS was 75.8±14.6 in group A, 73.2±13.1 in group B, 78.5±10.2 in group A1, 76.8±9.5 in group A2, 72.2±12.6 in group B1 and 77.4±18.3 in group B2. The AMS at the last follow-up was 90.7±10.5 in group A, 89.5±12.4 in group B, 91.3±13.2 in group A1, 90.7±14.8 in group A2, 88.5±11.2 in group B1 and 92.4±13.6 in group B2. There was no significant difference between groups A and B or between the subgroups A1 and A2 and groups B1 and group B2. The AMS was 75.8±14.6 after the first-stage surgery and 90.7±10.5 at the last follow-up in group A, significantly higher than those in group B （73.2±13.1 and 89.5±12.4, respectively, P〈0.05）. Conclusion Staged surgery is effective for treatment of central cord syndrome of the cervical spine, and the effect of the surgery is not related to the patients＇ age or the range of decompression.

关 键 词：颈椎 脊髓损伤 中央综合征 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]