脊髓梳理治疗急性胸腰段脊髓损伤伴硬脊膜破裂的效果观察  

Therapeutic effect of spinal cord combing in the treatment of acute thoracolumbar spinal cord injury complicated with dural rupture

作　　者：杨九杰 李治[2] 赵伟[2] 杨立枫[2] 田野 YANG Jiu-jie;LI Zhi;ZHAO Wei;YANG Li-feng;TIAN Ye(Shenyang Medical College,Shenyang 110034,China;Department of Spine Surgery,Central Hospital Affiliated to Shenyang Medical College,Shenyang 110024,China;Department of Orthopedic Surgery,Peking Union Medical College Hospital,Beijing 110730,China)

机构地区：[1]沈阳医学院,沈阳110034 [2]沈阳医学院附属中心医院脊柱外科,沈阳110024 [3]中国医学科学院北京协和医院骨科,北京110730

出　　处：《中国医学前沿杂志（电子版）》2019年第11期77-81,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：辽宁省科学技术计划项目(201602437)

摘　　要：目的探究急性胸腰段脊髓损伤伴硬脊膜破裂患者行脊髓梳理的临床疗效。方法回顾性分析2011年6月至2017年1月沈阳医学院附属中心医院收治的55例急性胸腰段脊髓损伤合并全瘫患者的临床资料,根据术中所见将硬脊膜破裂者纳入试验组,无硬脊膜破裂者纳入对照组。对照组患者施行后路椎板切除减压、椎弓根钉棒系统内固定术。试验组患者在对照组基础上行脊髓梳理术、硬脊膜修补。术后所有患者遵循相同的康复计划,随访时间为1~4年,平均随访(2.2±1.1)年。采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)运动评分和触觉评分评估两组患者术前和术后1年的神经功能;采用ASIA脊髓损伤分级评价两组患者术后1年脊髓损伤恢复的优良率。结果术前,两组患者ASIA运动评分和触觉评分比较均无统计学意义(均P>0.05);术后1年,两组患者上述指标均较术前显著提高(均P<0.05),且试验组患者上述指标均显著高于对照组(均P<0.05)。术后1年,试验组患者脊髓损伤恢复优良率显著高于对照组(χ^2=8.621,P=0.003)。结论急性胸腰段脊髓损伤伴硬脊膜破裂患者行脊髓梳理手术,预后优良,可提高患者术后生活质量,值得临床推广使用。Objective To explore the clinical efficacy of spinal cord combing in the treatment of acute thoracolumbar spinal cord injury complicated with dural rupture.Method Retrospective analyzed the clinical data of 55 patients with acute thoracolumbar spinal cord injury complicated with total sputum admitted to the Central Hospital Affiliated to Shenyang Medical College from June 2011 to January 2017.According to the intraoperative findings,patients with dural rupture were included in experimental group,and those without dural rupture were included in control group.Patients in control group underwent posterior laminectomy and decompression and pedicle screw-rod system internal fixation.Patients in experimental group underwent spinal cord combing and dural repair on this basis.All patients underwent the same rehabilitation program after surgery.The follow-up period was 1 to 4 years,and the average follow-up time was(2.2±1.1)years.The American Spinal Cord Injury Association(ASIA)exercise score and tactile score were used to evaluate the preoperative and postoperative 1 year neurological function;the ASIA spinal cord injury grading was used to evaluate the excellent rate of recovery of spinal cord injury in 1 year after operation in both groups.Result Before treatment,there were no significant differences in ASIA exercise scores and tactile scores between the two groups(all P>0.05).1 year after operation,the above indexes were significantly higher than those before surgery(all P<0.05),and the above indexes in experimental group were significantly higher than those in control group(all P<0.05).1 year after operation,excellent rate of spinal cord injury recovery in the experimental group was significantly higher than that in control group(χ^2=8.621,P=0.003).Conclusion Patients with acute thoracolumbar spinal cord injury complicated with dural rupture undergo spinal cord combing has excellent prognosis,which can improve the quality of life of patients in the future.It is worthy of clinical promotion.

关 键 词：急性胸腰段脊髓损伤 硬脊膜破裂 脊髓梳理 

分 类 号：R47[医药卫生—护理学]