颈椎前路减压融合内固定治疗成人无骨折脱位型颈脊髓损伤的疗效分析  

Anterior cervical decompression and fusion with internal fixation for the treatment of spinal cord injury without fracture and dislocation in adults

作　　者：戴斌[1] 张兵[1] 王金荣[1] 邓伟[1] 沈海滨[1] 陈东[1] 董启榕[2] 沈忆新[2] 徐又佳[2] DAI Bin ZHANG Bing WANG Jin-rong DENG Wei SHEN Hai-bin CHEN Dong DONG Qi- rong SHEN Yi-xin XU You-jia(Department of Orthopedics ,Binhai County People＇s Hospital ,Binhai 224500, China Department of Orthopaedics, the Second Affiliated Hospital, Soochow University, Suzhou 215004, China)

机构地区：[1]滨海县人民医院骨科,江苏滨海224500 [2]苏州大学附属第二医院骨科,江苏苏州215004

出　　处：《现代医学》2017年第2期210-214,共5页Modern Medical Journal

摘　　要：目的:探讨颈椎前路减压融合内固定术治疗成人无骨折脱位型颈脊髓损伤的临床效果。方法:回顾性分析24例手术治疗的成人无骨折脱位型颈脊髓损伤患者的临床资料。术前通过颈椎X线、CT、MRI检查排除颈椎骨折,同时评估存在的基础病变,确定有颈椎后纵韧带骨化2例,发育性颈椎管狭窄2例,退变性颈椎管狭窄13例,颈椎间盘突出5例,无颈椎基础病变2例;颈椎MRI提示所有患者均有不同程度的颈段脊髓受压、变性,表现为T2相高信号或混杂信号改变;病变单节段2例,两节段18例,3节段4例;均行前路减压椎间融合固定术。按美国脊髓损伤协会(ASIA)分级标准和日本骨科协会(JOA)评分评价患者入院时和术后及1、3、6、12个月随访时脊髓神经功能。结果:24例随访时间12~18个月,平均13.4个月。患者脊髓功能ASIA分级:入院时A级2例,B级4例,C级6例,D级12例,E级0例;术后12个月随访时A级2例,B级0例,C级3例,D级17例,E级2例。脊髓功能分级在手术前后比较差异具有统计学意义(P<0.05)。入院时JOA评分0~9分,平均3.6分。术后JOA评分平均增加4.1分,随访1、3、6、12个月JOA评分平均增加6.7、7.8、8.1、10.5分,与术前相比差异具有统计学意义(P<0.05)。结论:对于成人无骨折脱位型颈脊髓损伤,病变受累在三节段及以下的患者,前路减压融合内固定可获得较好的临床疗效。Objective： To investigate the clinical effect of anterior cervical spine surgery in the treatment of cervical spinal cord injury without fracture and dislocation in adults. Methods： A retrospective analysis of 24 cases of surgical treatment in our hospital clinical data of patients with adult no fracture dislocation cervical spinal cord injury, preoperative X-ray, CT and MRI through the examination to exclude cervical fracture, and evaluate the basic disease. 2 cases have the ossification of posterior longitudinal ligament. There are 2 cases with developmental cervical stenosis, 13 cases of degenerative cervical stenosis, 5 cases with cervical disc herniation and 2 cases without cervical lesions. All of patients had spinal cord injury and edema in MRI. There are 8 cases with spinal cord hemorrhage or hematoma, 4 cases with spinal cord or cavity. 2 cases are single segment, 18 cases are two segments. 4 cases are three segments. All patients underwent anterior decompression and internal fusion fixation. According to the American Spinal Cord Injury Association （ASIA） classification criteria and JOA score, all of patients were evaluated spinal nerve function prior to hospitalization and after surgery 1, 3, 6, 12 month. Results： 24 cases were followed up for 6-18 months, with an average of 13.4 months. In patients with spinal cord function in ASIA classification： There are admission grade A in 2 cases, grade B in 4 cases, 6 cases of grade C, 12 cases of grade D, E grade 0 cases. Postoperative 12 months of follow-up, there are 2 cases of Grade A, grade B 0 case, 3 cases of grade C, 17 cases of grade D, 2 cases of Grade E. The improvement of spinal function classification was statistically significant （P〈0.05） before and after operation. Admission JOA score is 0-9 points, an average of 3.6 points. Postoperative JOA score increased by an average of 4.1 points, followed by 1, 3, 6, 12 month, the results showed that the JOA score increased by an average of 6.7 points, 7.8 three or less segments.

关 键 词：颈椎 脊髓损伤 减压固定 无骨折脱位 

分 类 号：R683[医药卫生—骨科学]