下颈椎外伤后脊髓继发性损伤的防治策略  

Preventive strategies of secondary spinal cord injury caused by subaxial cervical trauma

作　　者：刘瑞端[1] 贾长青[1] 付勤[1] 梁峰[1] 杨杰[1] 

机构地区：[1]中国医科大学盛京医院脊柱关节外科,辽宁沈阳110004

出　　处：《中国骨伤》2010年第11期860-863,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨和总结下颈椎外伤后脊髓继发性损伤的防治策略。方法:2004年4月至2009年4月对67例下颈椎外伤后脊髓继发性损伤的患者进行回顾性分析,其中男47例,女20例;年龄18～69岁,平均40.5岁。入院后采取甲基强的松龙(MP)和神经节苷酯(GM-1)等药物应用、早期手术减压、术后高压氧的治疗等措施预防脊髓继发性损伤。神经功能依据Frankel分级,疗效评定采用总恢复率和有用恢复率。总恢复率为Frankel分级升高1级及1级以上者,有用恢复率为患者恢复到可以行走或可以扶拐行走,但残留某种神经功能障碍者,指Frankel分级D和E级。结果:63例获得随访,时间1～3年,平均1.5年。患者总恢复率为53.7%(36/67),有用恢复率为35.8%(24/67);死亡7例,加重1例。结论:及时应用甲基强的松龙(MP)、神经节苷酯(GM-1)等药物,早期手术减压,术后高压氧治疗可以有效地防治颈椎外伤后脊髓的继发性损伤;术前减少不必要搬动,术中谨慎操作也可减少医源性脊髓损伤的发生。Objective：To summarize and analyze preventive strategies of secondary spinal cord injury caused by subaxial cervical trauma. Methods：From April 2004 to April 2009,67 patients with secondary spinal cord injury caused by subaxial cervical trauma were retrospectively analyzed. There were 40 males and 20 females,with an average age of 40.5 years old ranging from 18 to 69 years. After admission the preventive strategies included using MP and GM-1,early decompression,and high pressure oxygen after operation. The neurological function was classified by Frankel,and the therapeutic effect was evaluated by total recovery rate and useful recovery rate. The total recovery rate was that the level of Frankel raise one or more grade,the useful recovery rate which included Frankel D,E was that the patient can walk by self or crutch,remaining some neurological deficits. Results：All patients were followed up for 1 to 3 years （averaged 1.5 years）,the total recovery rate was 53.7% （36/67）,the useful recovery rate was 35.8% （24 / 67）. Seven patients was death,the death rate was10.4% （7 / 67）,1 was aggravated,the aggravating rate was 1.5% （1 / 67）. Conclusion：As possible as using MP,GM-1,early decompression,and high pressure oxygen after operation can be effective strategies for preventing secondary spinal cord injury caused by subaxial cervical trauma.

关 键 词：颈椎 脊髓损伤 外科手术 药物疗法 高压氧 

分 类 号：R651.2[医药卫生—外科学]