无骨折脱位型颈脊髓损伤手术治疗近期预后影响因素分析  

Analysis of factors affecting short-term prognosis of surgical treatment of cervical spinal cord injury without fracture and dislocation

作　　者：张立军[1] ZHANG Li-jun(Department of Orthopedics,Mentougou District Hospital,Beijing,102300,China)

机构地区：[1]北京市门头沟区医院骨科,北京102300

出　　处：《颈腰痛杂志》2023年第3期340-342,348,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨无骨折脱位型颈脊髓损伤手术治疗近期预后影响因素。方法本研究对象为2016年1月~2020年1月本院手术治疗的104例无骨折脱位型颈脊髓损伤患者,平均随访(24.91±3.88)个月。术前、末次随访时评估JOA评分,并根据JOA评分改善情况设为优良组以及可差组。调查两组患者性别、年龄、脊髓MRI信号改变等临床资料,采用单因素与多因素分析的方式探讨手术治疗近期预后的影响因素。结果104例患者术后JOA评分改善情况:优24例,良48例,可22例,差10例。优良组、可差组的损伤节段数、椎管侵占率、脊髓MRI信号改变、ASIA分级、手术时间、手术时机、术中出血量差异有统计学意义(P<0.05),两组性别、年龄、激素冲击治疗的差异无统计学意义(P>0.05);多因素分析显示,损伤节段数>3个、椎管侵占率>70%,脊髓MRI信号改变、ASIA分级B级是近期预后的影响因素。结论手术治疗无骨折脱位型颈脊髓损伤具有良好的治疗效果,但损伤节段多、椎管侵占率高,脊髓MRI信号改变、脊髓功能差是预后不良的影响因素。Objective To explore the factors affecting the short-term prognosis of surgical treatment of cervical spinal cord injury without fracture and dislocation.Methods A total of 104 patients with cervical spinal cord injury without fracture and dislocation in our hospital from January 2016 to January 2020 were selected as the study subjects.All were treated with surgery,with an average follow-up of(24.91±3.88)months.The JOA score was evaluated preoperatively and in the final follow-up.The excellent group and the poor group were set according to the JOA score improvement.The clinical data of the two groups of patients,such as gender,age,and spinal cord MRI signal changes were investigated.The single factor and multiple factor analysis were used to explore the factors affecting the short-term prognosis of surgical treatment.Results The improvement of postoperative JOA score in 104 cases of patients was as follows:excellent results in 24 cases,good in 48 cases,fair in 22 cases,and poor in 10 cases.There were statistically significant differences in the number of injured segments,spinal canal invasion rate,spinal cord MRI signal changes,ASIA classification,operation time,operation timing,and intraoperative blood loss between the excellent group and the poor group(P<0.05).There was no significant difference in gender,age and hormone shock treatment between the two groups(P>0.05).Multivariate analysis showed that the number of injured segments>3,spinal canal invasion rate>70%,changes in spinal cord MRI signal and ASIA grade B were the influencing factors for the short-term prognosis.Conclusion Surgical treatment of cervical spinal cord injury without fracture and dislocation has a good therapeutic effect,but the influencing factors of poor prognosis are many injured segments,a high rate of spinal canal invasion,changes in spinal cord MRI signals,and poor spinal cord function.

关 键 词：无骨折脱位型颈脊髓损伤 手术治疗 脊髓功能 

分 类 号：R683.2[医药卫生—骨科学]