无骨折脱位型颈椎脊髓损伤的治疗策略  

Treatment strategy of cervical spinal cord injury without fracture and dislocation

作　　者：代杰[1] 盛伟斌[2] 谢江[1] 马原[1] DAI Jie;SHENG Wei-bin;XIE Jiang;MA Yuan(Department of Spinal Surgery,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830000,China;不详)

机构地区：[1]新疆医科大学第六附属医院脊柱外科,新疆乌鲁木齐830000 [2]新疆医科大学第一附属医院脊柱外科

出　　处：《中国骨与关节损伤杂志》2020年第7期673-675,共3页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(81760411)。

摘　　要：目的探讨无骨折脱位型颈椎脊髓损伤的治疗方案。方法回顾性分析自2010-07—2015-03诊治的42例无骨折脱位型颈椎脊髓损伤,12例采用非手术治疗,19例采用颈椎前路椎间盘切除融合术或颈椎前路椎体次全切除融合术治疗,11例采用颈椎后路单开门扩大椎管减压术治疗。16例在受伤后7 d内进行手术,14例在受伤7 d后进行手术。结果42例均顺利完成治疗,随访时间平均51.4(48~66)个月。前路内固定手术植骨均融合,后路手术减压后均未出现"关门"现象,术后均未出现内固定松动、脱位和断裂等并发症。末次随访时采用手术治疗患者JOA评分较采用非手术治疗患者高,术后3 d及末次随访时损伤7 d内手术者JOA评分较损伤7 d后手术者高,差异有统计学意义(P <0.05)。末次随访时Frankel等级:C级1例,D级8例,E级33例;末次随访时Frankel等级较治疗前改善,差异有统计学意义(P <0.05)。结论无骨折脱位型颈椎脊髓损伤早期手术可直接解除脊髓压迫并取得满意的临床疗效,值得临床推广。Objective To explore the treatment options for cervical spinal cord injury without fracture and dislocation.Methods Retrospective analysis of 42 patients with cervical spinal cord injury without fracture and dislocation diagnosed and treated from July 2010 to March 2015 was performed, 12 cases were treated with non-surgical treatment, 19 cases were treated with anterior cervical discectomy and fusion or anterior cervical spine for total resection and fusion, 11 cases underwent cervical decompression with single-door open posterior approach;16 patients underwent surgery within 7 days after injury, and 14 cases underwent surgery within 7 days after injury. Results All 42 patients successfully completed the treatment, with an average follow-up time of 51.4(48-66) months. The bone grafts of the anterior internal fixation surgery were all fused, and there was no "closed door" phenomenon after the decompression of the posterior operation. There were no complications such as loosening, dislocation and fracture of the internal fixation after operation. The JOA score of patients treated with surgery at the last follow-up was higher than that of patients treated with non-surgical treatment. At 3 days after the operation and at the last follow-up, the JOA score of the operation within 7 days of injury was higher than that after 7 days of injury(P <0.05). At the last follow-up, 1 case was Frankel grade C, 8 cases D grade, and 33 cases E grade. The Frankel grade was improved after treatment, the difference was statistically significant(P <0.05). Conclusion Early surgical treatment of cervical spinal cord injury without fracture and dislocation can directly relieve spinal cord compression and obtain satisfactory clinical efficacy, which is worthy of clinical promotion.

关 键 词：无骨折脱位型脊髓损伤 手术治疗 非手术治疗 JOA评分 

分 类 号：R681.5[医药卫生—骨科学]