颈椎过伸性损伤前路减压融合术的手术时机  

Surgical timing of anterior decompression and fusion for cervical hyperextension injury

作　　者：韩森东 余智 HAN Sen-dong;YU Zhi(Jiangbei District of Zhongda Hospital,Southeast University,Nanjing 210048,China)

机构地区：[1]东南大学附属中大医院江北院区(南京市大厂医院),江苏南京210048

出　　处：《中国矫形外科杂志》2020年第14期1254-1258,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81302304)。

摘　　要：[目的]探究颈椎过伸性损伤前路减压融合术手术时机对治疗效果的影响。[方法]2013年4月~2018年3月本院手术治疗60例颈椎过伸性损伤的患者,根据患者伤后至接受手术治疗的时间分为≤3 h组和>3 h组,每组30例。比较两组患者的围手术期、随访和影像资料。[结果]所有患者均顺利完成手术,术中均无血管、神经损伤等严重并发症。两组患者在手术时间、术中出血量、引流量和术后住院时间的差异均无统计学意义(P>0.05)。随访时间12~14个月,平均(12.52±1.41)个月。术后12个月,两组患者VAS和ODI评分均较术前显著减少,差异有统计学意义(P<0.05);随时间推移,两组患者JOA评分均显著增加(P<0.05),ASIA分级显著上调,不同时间点差异有统计学意义(P<0.05)。术后12个月时,≤3 h组的VAS和ODI评分显著低于>3 h组(P<0.05);术后1个月和12个月,≤3 h组的JOA评分显著高于>3 h组(P<0.05);术后1个月和12个月,≤3 h组的ASIA神经功能评级显著优于>3 h组(P<0.05)。影像学结果显示,术后12个月,≤3 h组术后前柱高度以及Cobb角恢复显著优于>3 h组(P<0.05)。[结论]对颈椎过伸性损伤,应早期进行手术治疗,以最大程度的恢复受损的神经功能。[Objective]To explore the effect of surgical timing on outcomes of anterior decompression and instrumented fusion for cervical hyperextension injury.[Methods]From April 2013 to March 2018,a total of 60 patients underwent anterior cervical decompression and fusion for cervical hyperextension injury in our hospital.Based on the time elapsed between injury and surgical interference,the patients were divided into the less than or equal to 3 hours group(the≤3 h group)and the more than 3 hours group(the>3 h group),with 30 patients in each group.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]All patients in both groups had operation performed successfully without grim complications,such as neurovascular injuries.There were no statistically significant differences regarding operation time,intraoperative blood loss,postoperative drainage and hospital stay between the two groups(P>0.05).The patients were followed up for 12~14 months,with an average of(12.52±1.41)months.The VAS and ODI scores significantly decreased at 12 months after operation in both groups compared with those before operation(P<0.05),whereas the JOA score and ASIA neurological functional grade significantly improved over time in both groups(P<0.05).At 12 months postoperatively,the≤3 h group proved significantly superior to the>3 h group in VAS,ODI and JOA scores,as well as ASIA grade(P<0.05).With respect of radiographic evaluation,the≤3 h group got significantly superior recovery in anterior column height and Cobb's angle to the>3 h group(P<0.05).[Conclusion]For cervical hyperextension injury,the anterior cervical decompression and fusion should be performed as soon as possible to facilitate maximal neurological recovery.

关 键 词：颈椎过伸性损伤 手术时机 前路颈椎减压融合术 临床结果 

分 类 号：R683.2[医药卫生—骨科学]