前后路两种术式治疗老年患者无骨折脱位型颈脊髓损伤的对比研究  

Comparative study on the effects of anterior versus posterior approaches surgery in elderly patients with cervical spinal cord injury without radiographic abnormality

作　　者：王强[1] 孙常太[1] 张良[1] 纪泉[1] 张啟维[1] Wang Qiang;Sun Changtai;Zhang Liang;Ji Quan;Zhang Qiwei(Department of Orthopaedics,Beijing Hospital,National Center of Gerontology,Insitule of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院骨科国家老年医学中心中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第12期1560-1564,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨前后路两种术式治疗老年患者无骨折脱位型颈脊髓损伤手术效果的优劣。方法回顾性分析自2014年1月至2018年12月在北京医院行减压手术治疗并获得12个月完整随访的无骨折脱位型颈脊髓损伤的老年患者共31例, 分析其损伤节段、致伤原因等临床特点, 并按减压手术入路分为前路手术组和后路手术组, 比较两组患者手术时间、手术中出血量、术后引流量, 分析手术前、手术后3周、手术后3个月、6个月、12个月日本骨科协会(JOA)颈脊髓功能评定结果的差异。结果前、后路手术组中位手术时间分别为100.0(90.0, 110.0)min和132.5(123.7, 140.0)min, 中位出血量分别为30.0(20.0, 35.0)ml和175.0(150.0, 202.5)ml, 中位术后引流量分别为20.0(10.0, 20.0)ml和210.0(197.5, 237.5)ml, 两组比较差别均有统计学意义(U=18.00、0.00、0.00, 均P<0.01)。前路手术组术前、术后3周、术后3个月、术后6个月、术后12个月JOA中位评分分别为4.0(3.0, 5.0)分、6.0(5.5, 8.5)分、9.0(8.5, 11.0)分、11.0(10.0, 12.5)分、12.0(11.0, 13.0)分, 后路手术组分别为4.0(3.0, 7.3)分、6.5(5.7, 10.0)分、10.5(8.7, 12.3)分、12.5(11.0, 13.0)分、13.0(11.0, 13.3)分, 两组比较差异均无统计学意义(U=89.01、90.03、85.50、74.02、89.54, P=0.52、0.55、0.42、0.20、0.52), 但不同时间点比较差异均有统计学意义(χ^(2)=82.46、39.23, 均P<0.01), 且两两比较结果显示, 后一时间点的JOA评分较前一时间点均有提高, 差别均有统计学意义(均P<0.05)。结论前路手术和后路手术对老年无骨折脱位型颈脊髓损伤患者的脊髓功能恢复均有良好效果, 但前路手术时间短、出血少、引流量少、恢复快, 为首选手术方式。Objective To explore the advantages and disadvantages of anterior versus posterior approach surgery in the treatment of cervical spinal cord injury without radiographic abnormality in elderly patients.Methods Clinical data of 31 geriatric patients of spinal cord injuries without radiographic abnormality in our department from January 2014 to December 2018 were retrospectively analyzed for the cause of injury and the extent of injury.The patients were divided into two groups:anterior approach operation group and posterior approach operation group.The operation time,blood loss.volume of drainage.Japanese Orthopaedic Association(JOA)score before operation and 3 weeks.3 months.6 months.12 months after operation.were recorded in the two groups..Results Comparing the anterior versus posterior approach operation groups.the median operation time were 100.0(90.0.110.0)min versus 132.5(123.7,140.0)min.the median bleeding volume was 30.0(20.0.35.0)ml versus 175.0(150.0.202.5)ml,and the median postoperative drainage volume was 20.0(10.0.20.0)ml versus 210.0(197.5.237.5)ml,respectively,with statistically significantly differences between the two groups(U=18.00、0.00、0.00,all P<0.01).When comparing the anterior versus posterior approach operation groups,the median JOA scores at 5 time points were 4.0(3.0.5.0).6.0(5.5.8.5).9.0(8.5.11.0).11.0(10.0.12.5).12.0(11.0.13.0)in the anterior operation group.and 4.0(3.0.7.3).6.5(5.7.10.0).10.5(8.7.12.3).12.5(11.0.13.0).13.0(11.0.13.3)in the posterior operation group.with no significantly difference between the 1wo groups(U=89.01.90.03.85.50,74.02.89.54.P=0.52,0.55.0.42.0.20.0.52).but there was significant difference in the median JOA scores at each of five different time points(χ^(2)=82.46.39.23,all P<0.01).Interestingly.the JOA score was higher at the latter time point than at the previous time point,with statistically significantly differences(all P<0.05).Conclusions Both anterior and posterior approaches for decompression surgery have good effects on the recovery of spinal cord fu

关 键 词：脊髓损伤 临床特点 

分 类 号：R651.2[医药卫生—外科学]