成人多节段无骨折脱位型颈脊髓损伤不同治疗方法的疗效对比分析  

Comparative analysis of treatment efficacy of different methods on multiple segmental adult cervical spinal cord injury without fracture dislocation

作　　者：张广泉[1] 刘珂[1] 高延征[1] 陈书连[1] 高坤[1] 赵永强[1] 高宗炎[1] 

机构地区：[1]河南省人民医院骨科,郑州450003

出　　处：《中华神经医学杂志》2013年第9期940-943,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨手术和神经生长因子应用在治疗成人多节段无骨折脱位型颈脊髓损伤中的作用。方法回顾性分析河南省人民医院骨科自2004年1月至2011年5月治疗并获得随访的68例成人多节段无骨折脱位型颈脊髓患者临床资料，根据患者意愿将68例患者分为A、B、C3组，A组18例，采取保守治疗，行颈椎牵引的基础上加用激素、弥可保等药物治疗；B组25例，采用颈3～7后路单开门椎管扩大成形术进行治疗．术后应用弥可保：C组25例，在B组基础上加用神经生长因子，1次／d，每次1支（18μg／支），用2mL注射用水溶解后肌肉注射，4周为一疗程。治疗后3月、6月、12月进行随访，通过日本骨科学会（JOA）颈脊髓功能评定标准评估临床疗效。结果治疗后3、6、12个月3组患者JOA评分差异均有统计学意义（P〈0．051，其中B、C组各时间点评分均高于A组，C组评分治疗后6、12个月时高于B组，差异有统计学意义（P〈0．05）。结论手术治疗较保守治疗效果更好，外源性神经生长因子有助于促进脊髓损伤的修复。Objective To investigate the treatment effects of operation and nerve growth factor on adult multisegrnental cervical spinal cord injury without fracture dislocation. Methods Sixty-eight patients with multiple segmental cervical spinal cord injury without fracture dislocation, admitted to our hospital from January 2004 to May 2011, were chosen in our study; according to the will of the patients, 18 patients received conservative treatment （group A）, 25 patients were treated by posterior single open-door laminoplasty （group B） and the other 25 patients were treated with posterior single open-door laminoplasty combined with nerve growth factor （group C, once daily for 4 weeks）; their clinical data were retrospectively analyzed. Follow up was performed at 3, 6 and 12 months after the treatments; Japanese Orthopaedic Association （JOA） scale was employed to evaluate the clinical efficacy. Results Three, 6, 12 months after the treatments, the JOA scale scores were statistically different among the three groups （P〈0.05）; the scores in group B and C were significantly higher than those in group A at all time points （P〈0.05）; 6 and 12 months after the treatmemts, the JOA scale scores in group C were significantly higher than those in group B （P〈0.05）. Conclusion To patients with multisegmental cervical spinal cord injury without fracture dislocation, conservative treatment can make the spinal cord function partially restored, but the effect is limited; exogenous nerve growth factor has good repairing effect on spinal cord injury.

关 键 词：无骨折脱位 脊髓损伤 神经生长因子 外科手术 

分 类 号：R651.2[医药卫生—外科学]