早期颈前路手术治疗多节段急性颈椎间盘突出并脊髓损伤的研究  

Early anterior approach operation with internal fixation in treatment of acute multilevel cervical disc herniation patients with cervical spinal cord injury

作　　者：李晓彬[1] 刘涛[1] 程应全[1] 王伟[1] 

机构地区：[1]河南省人民医院急诊创伤外科,郑州450003

出　　处：《中华神经医学杂志》2012年第10期1042-1045,共4页Chinese Journal of Neuromedicine

摘　　要：目的 探讨早期颈前路手术治疗多节段急性颈椎间盘突出引起的颈脊髓损伤的临床疗效。方法 河南省人民医院急诊创伤外科自2010年1月至2011年1月采用早期颈前、钛网联合cage配合自锁钛板前路减压和重建术治疗急性颈椎间盘突出引起的脊髓损伤患者23例，其中受伤后72h内接受手术14例，72h后接受手术9例。回顾性分析患者的临床资料和术后脊髓损伤的恢复程度。结果 本组患者随访6～13个月（平均11个月）。X线检查显示融合节段均获骨性融合，无内固定松动断裂及椎间融合器下沉等并发症发生；除1例美国脊髓损伤协会（ASIA）分级为A级的患者症状未有改善外，其余患者术后症状均得到较好改善；治疗后2组患者的JOA评分较术前都有明显提高，且治疗后72h内手术组JOA评分及JOA改善率高于72h后手术组，差异有统计学意义（P〈0．05）。结论 早期颈前路手术可使多节段急性颈椎间盘突出所致脊髓损伤得到改善和恢复，手术时机越早恢复越好，术后手术节段获得即刻稳定，融合效果确定，临床效果满意。Objective To evaluate the clinical effect of early anterior approach operation with internal fixation in treating traumatic cervical disc herniation patients with cervical spinal cord injury. Methods Twenty-three patients with spinal cord injury caused by acute cervical disc herniation, admitted to our hospital fi＇om January 2010 to January 2011, were chosen in our study; all patients underwent anterior cervical surgery with the application of titanium mesh plate and cage to perform decompression and reconstruction; 14 patients received surgery within 72 h of injury and other 9 adopted surgery after 72 h of injury. The clinical data and postoperative recovery degree of the spinal cord injury were retrospectively analyzed. Results All patients were followed up for 6 to 13 months （averaged 11 months）. X-ray examination showed bony fusion in the fusion segments without loosening/breakage of internal fixation or interbody fusion sinking. Except for 1 patient having grade A according to American Spinal Injury Association （ASIA） criteria enjoyed no recovery after the operation, the remaining patients enjoyed good improvement. The postoperative average Japanese Orthopedic Association （JOA） scale scores were significantly higher than those before surgery; the postoperative average JOA scale scores and recovery ratio of JOA in patients received surgery within 72 h of injury were obviously higher than those in patients received surgery over 72 h of injury （/9〈0.05）. Conclusion Early anterior titanium mesh combined with cage and locking plate operation can make acute cervical disc herniation patients with spinal cord injury get rapid improvement and restoration; the earlier the operation time, the better the recovery degree; surgery can make cervical operation section obtain immediate stability, fusion and clinical effects are satisfied.

关 键 词：急性颈椎间盘突出症 钛网 钛板 椎间融合器 

分 类 号：R687.3[医药卫生—骨科学]